Treating hyperglycemia promotes better outcomes among inpatients. Knowledge deficits about management of inpatient diabetes are prevalent among resident physicians, which may affect the care of a substantial number of these patients.
Methods:
A computer-based training (CBT) curriculum on inpatient diabetes and hyperglycemia was developed and implemented for use by resident physicians and focuses on several aspects of the management of inpatient diabetes and hyperglycemia: (1) review of importance of inpatient glucose control, (2) overview of institution-specific data, (3) triaging and initial admission actions for diabetes or hyperglycemia, (4) overview of pharmacologic management, (5) insulin-dosing calculations and ordering simulations, (6) review of existing policies and procedures, and (7) discharge planning. The curriculum was first provided as a series of lectures, then formatted and placed on the institutional intranet as a CBT program.
Results:
Residents began using the inpatient CBT in September 2008. By August 2009, a total of 29 residents had participated in CBT: 8 in family medicine, 12 in internal medicine, and 9 in general surgery. Most of the 29 residents confirmed that module content met stated objectives, considered the information valuable to their inpatient practices, and believed that the quality of the online modules met expectations. The majority reported that the modules took just the right amount of time to complete (typically 30 min each).
Conclusions:
Improvement in inpatient diabetes care requires continuous educational efforts. The CBT format and curriculum content were well accepted by the resident physicians. Ongoing assessment must determine whether resident practice patterns are influenced by such training.
ClementSBraithwaiteSSMageeMFAhmannASmithEPSchaferRGHirschIB, American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals. Diabetes Care.2004;27 (2): 553–91.
2.
MoghissiESKorytkowskiMTDiNardoMEinhornDHellmanRHirschIBInzucchiSEIsmail-BeigiFKirkmanMSUmpierrezGE, American Association of Clinical Endocrinologists, American Diabetes Association. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract.2009;15 (4): 353–69.
3.
American College of Endocrinology and American Diabetes Association Task Force on Inpatient Diabetes. American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control. Endocr Pract.2006;12 (4): 458–68.
4.
BraithwaiteSSMageeMSharrettsJMSchnipperJLAminAMaynardG, Society of Hospital Medicine Glycemic Control Task Force. The case for supporting inpatient glycemic control programs now: the evidence and beyond. J Hosp Med.2008;3 (5 Suppl): 6–16.
CookCBStocktonLBairdMOsburneRCDavidsonPCSteedRDBodeBWReidJMcGowanKA. Working to improve care of hospital hyperglycemia through statewide collaboration: the Georgia Hospital Association Diabetes Special Interest Group. Endocr Pract.2007;13 (1): 45–50.
UmpierrezGMaynardG. Glycemic chaos (not glycemic control) still the rule for inpatient care: how do we stop the insanity?. J Hosp Med.2006;1 (3): 141–4.
11.
LevetanCSPassaroMJablonskiKKassMRatnerRE. Unrecognized diabetes among hospitalized patients. Diabetes Care.1998;21 (2): 246–9.
12.
SchnipperJLBarskyEEShaykevichSFitzmauriceGPendergrassML. Inpatient management of diabetes and hyperglycemia among general medicine patients at a large teaching hospital. J Hosp Med.2006;1 (3): 145–50.
13.
KnechtLAGauthierSMCastroJCSchmidtREWhitakerMDZimmermanRSMisharkKJCookCB. Diabetes care in the hospital: is there clinical inertia?. J Hosp Med.2006;1 (3): 151–60.
14.
CookCBCastroJCSchmidtREGauthierSMWhitakerMDRoustLRArguetaRHullBPZimmermanRS. Diabetes care in hospitalized noncritically ill patients: more evidence for clinical inertia and negative therapeutic momentum. J Hosp Med.2007;2 (4): 203–11.
15.
Institute for Safe Medication Practices. Complexity of insulin therapy has risen sharply in the past decade. ISMP Medication Safety Alert.2004;3: 1.
CookCB. Creating “glycemic order” out of “glycemic chaos” [letter]. J Hosp Med.2006;1: 383–5.
19.
CookCBZimmermanRSGauthierSMCastroJCJamesonKALittmanSDMagallanezJM. Understanding and improving management of inpatient diabetes mellitus: the Mayo Clinic Arizona experience. J Diabetes Sci Technol.2008;2 (6): 925–31.
20.
CookCBMcNaughtonDABraddyCMJamesonKARoustLRSmithSARobertsDLThomasSLHullBP. Management of inpatient hyperglycemia: assessing perceptions and barriers to care among resident physicians. Endocr Pract.2007;13 (2): 117–24.
21.
CookCBJamesonKAHartsellZCBoyleMELeonhardiBJFarquhar-SnowMBeerKA. Beliefs about hospital diabetes and perceived barriers to glucose management among inpatient midlevel practitioners. Diabetes Educ.2008;34 (1): 75–83.
22.
CheekatiVOsburneRCJamesonKACookCB. Perceptions of resident physicians about management of inpatient hyperglycemia in an urban hospital. J Hosp Med.2009;4 (1): E1–8.
23.
HammoudMGruppenLEricksonSSCoxSMEspeyEGoepfertAKatzNT, Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. To the point: reviews in medical education online computer assisted instruction materials. Am J Obstet Gynecol.2006;194 (4): 1064–9.
24.
GreenhalghT. Computer assisted learning in undergraduate medical education. BMJ.2001;322 (7277): 40–4.
25.
ZuckerSWhiteJAFabriPJKhonsariLS. Instructional intranets in graduate medical education. Acad Med.1998;73 (10): 1072–5.
26.
BellDSFonarowGCHaysRDMangioneCM. Self-study from web-based and printed guideline materials. A randomized, controlled trial among resident physicians. Ann Intern Med.2000;132 (12): 938–46.
27.
Minasian-BatmanianLC. Guidelines for developing an online learning strategy for your subject. Med Teach.2002;24 (6): 645–7.
28.
McKimmJJollieCCantillonP. ABC of learning and teaching: web based learning. BMJ.2003;326 (7394): 870–3.
29.
CookDADuprasDM. A practical guide to developing effective web-based learning. J Gen Intern Med.2004;19 (6): 698–707.
30.
BermanNBFallLHMaloneyCGLevineDA. Computer-assisted instruction in clinical education: a roadmap to increasing CAI implementation. Adv Health Sci Educ Theory Pract.2008;13 (3): 373–83.
31.
American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care.2009;32Suppl 1: S13–61.
32.
QuealeWSSeidlerAJBrancatiFL. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med.1997;157 (5): 545–52.
33.
GearhartJGDuncanJL3rdReplogleWHForbesRCWalleyEJ. Efficacy of sliding-scale insulin therapy: a comparison with prospective regimens. Fam Pract Res J.1994;14 (4): 313–22.
34.
UmpierrezGESmileyDZismanAPrietoLMPalacioACeronMPuigAMejiaR. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care.2007;30 (9): 2181–6.
35.
MaynardGLeeJPhillipsGFinkERenvallM. Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: effect of structured subcutaneous insulin orders and an insulin management algorithm. J Hosp Med.2009;4 (1): 3–15.
36.
SchnipperJLNdumeleCDLiangCLPendergrassML. Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: results of a clinical trial. J Hosp Med.2009;4 (1): 16–27.
37.
CookCBBoyleMECisarNSMiller-CageVBourgeoisPRoustLRSmithSAZimmermanRS. Use of continuous subcutaneous insulin infusion (insulin pump) therapy in the hospital setting: proposed guidelines and outcome measures. Diabetes Educ.2005;31 (6): 849–57.
CookCBSeifertKMHullBPHovanMJCharlesJCMiller-CageVBoyleMEHarrisJKMagallanezJMLittmanSD. Inpatient to outpatient transfer of diabetes care: planing for an effective hospital discharge. Endocr Pract.2009;15 (3): 263–9.
41.
NICE-SUGAR Study Investigators, FinferSChittockDRSuSYBlairDFosterDDhingraVBellomoRCookDDodekPHendersonWRHébertPCHeritierSHeylandDKMcArthurCMcDonaldEMitchellIMyburghJANortonRPotterJRobinsonBGRoncoJJ. Intensive versus conventional glucose control in critically ill patients. N Engl J Med.2009;360 (13): 1283–97.
