Hyperglycemia is associated with negative health outcomes such as increased infection, increased thrombosis, decreased wound healing and prolonged hospitalization. The 2022 ADA guidelines for hospitalized patients recommend targeting blood glucose (BG) 140-180 mg/dL in both critically and non-critically ill patients and managing persistent hyperglycemia with insulin. Data evaluating the impact of a pharmacist-managed insulin dosing protocol is currently lacking. The objective of this study was to evaluate the safety and efficacy of a pharmacist-managed basal-bolus (BB) insulin dosing protocol for inpatient hyperglycemia management. This single-center, retrospective, observational study included patients > 18yo with three consecutive BG concentrations 180-350mg/dL admitted to the critical care, telemetry, and medical/surgical floors. The insulin per pharmacy dosing protocol was implemented in December 2020. A total of 494 patients were included in the pre-implementation group (January-November 2020) and 668 patients in the post-implementation group (July-December 2021). No significant difference in baseline characteristics were observed between the two groups. For primary outcome, post-implementation group had a statistically significant higher percentage of normoglycemia defined as BG 70-180 mg/dL (63.4% vs. 50.2%, p<0.01) and a statistically significant lower percentage of hyperglycemia defined as BG >180 mg/dL (35.1% vs. 48.2%, p<0.01). No difference in hypoglycemia rate between the two groups were observed (1.6% vs. 1.5%, p>0.1) confirming protocol safety. For secondary outcome, no difference in average length of stay between the two groups, although goal BG<180 mg/dL was achieved on day 2 in post-implementation group vs. day 6 in pre-implementation group. This study suggests that pharmacists can effectively and safely manage inpatient hyperglycemia in both critically ill and non-critically ill patients utilizing a standardized BB insulin dosing protocol.
A.G.Hadiprodjo: None. E.M.Scott: None. R.Weng: None.
