1881-LB: Inpatient Hyperglycemia—How to Overcome This Challenge

Introduction & Objective: Inpatient hyperglycemia (IH) is a prevalent and clinically significant problem affecting millions of patients worldwide. IH is estimated to affect approximately 40% of hospitalized patients, with an even higher prevalence in intensive care units (ICUs), reaching up to 80%. The objective of introducing a protocol to control IH is to guarantee the achievement of the glycemic target in critically ill patients. The objective of this work is to show how in-service education and the involvement of various sectors can guarantee adherence, not only by the medical service, but by all sectors, especially nursing and the IT group.

Methods: Based on this data, from 2021 onwards, we introduced into our hospital service, which has more than 200 ICU beds, a protocol for the treatment of IH, which involves, in addition to the medical team, the nursing service, nutrition and the IT group. We initiate insulin use in critically ill patients with or without DM if there is hyperglycemia greater than 200 mg/dL, and continuous intravenous insulin infusion is the therapy of choice for them.

Results: After the introduction of the protocol there was a substantial decrease in the number of infections and days spent in ICU. The insulin pump adherence rate by the ICUs team was in 2021, 2022 and 2023, respectively: 82.1%, 88.9%, 95.7%. Hypoglycemia < 70 mg/dL rate was respectively 0.4%, 0.3%, 0.4%; Number of open files were respectively 2.559, 2,187, 1,514; Number of capillary blood glucose levels were respectively - 29,658, 23,944, 19,724.

Conclusion: We can observe that in the last year (2023) the adherence rate to the protocol improved and the hypoglycemia rate remained stable, in addition, the number of open records fell by almost 50%. The work aims to adapt IH, demonstrating that its management in critical beds is possible and can be carried out with the collaboration of everyone, which can be implemented in other sectors and other smaller hospitals.