Management of diabetes by a healthcare team in a cardiology unit: a randomized controlled trial

Maria Antonieta P de Moraes, Juliane Rodrigues, Mariana Cremonesi, Carisi Polanczyk, Beatriz D Schaan, Maria Antonieta P de Moraes, Juliane Rodrigues, Mariana Cremonesi, Carisi Polanczyk, Beatriz D Schaan

Abstract

Objective: To assess the effectiveness of healthcare team guidance in the implementation of a glycemic control protocol in the non-intensive care unit of a cardiology hospital.

Methods: This was a randomized clinical trial comparing 9 months of intensive guidance by a healthcare team on a protocol for diabetes care (Intervention Group, n = 95) with 9 months of standard care (Control Group, n = 87). Clinicaltrials.gov: NCT01154413.

Results: The mean age of the patients was 61.7±10 years, and the mean glycated hemoglobin level was 71±23 mmol/mol (8.7±2.1%). The mean capillary glycemia during hospitalization was similar between the groups (9.8±2.9 and 9.1±2.4 mmol/l for the Intervention Group and Control Group, respectively, p = 0.078). The number of hypoglycemic episodes (p = 0.77), hyperglycemic episodes (47 vs. 50 in the Intervention Group and Control Group, p = 0.35, respectively), and the length of stay in the hospital were similar between the groups (p = 0.64). The amount of regular insulin administered was 0 (0-10) IU in the Intervention Group and 28 (7-56) IU in the Control Group (p<0.001), and the amount of NPH insulin administered was similar between the groups (p = 0.16).

Conclusions: While guidance on a glycemic control protocol given by a healthcare team resulted in a modification of the therapeutic strategy, no changes in glycemic control, frequency of episodes of hypoglycemia and hyperglycemia, or hospitalization duration were observed.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
The diabetes management protocol. NPO: from Latin, Nil per os, which means nothing through the mouth.
Figure 2
Figure 2
Flow chart of patient randomization.
Figure 3
Figure 3
Panel A) Distribution of capillary glycemia (mean ± SD) during the first week of hospitalization in the groups studied. Panel B) Distribution of capillary glycemia (mean ± SD) for each 3-month evaluation in the groups studied. CG: control group (no guidance of the healthcare team); IG: intervention group (intensive guidance of the medical/nursing staff regarding the protocol).

References

    1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.
    1. Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatcliffe C, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010;33(8):1783–8.
    1. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82.
    1. Furnary AP, Wu Y, Bookin SO. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract. 2004;10(Suppl. 2):21–33.
    1. Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS. Tight glycemic control in diabetic coronary. artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004;109(12):1497–502.
    1. Malmberg K. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ. 1997;314(7093):1512–5.
    1. Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery) Diabetes Care. 2011;34(2):256–61.
    1. Roman SH, Chassin MR. Windows of opportunity to improve diabetes care when patients with diabetes are hospitalized for other conditions. Diabetes Care. 2001;24(8):1371–6.
    1. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27(2):553–91.
    1. Inzucchi SE. Clinical Practice Management of hyperglycemia in the hospital setting. N Engl J Med. 2006;355(18):1903–11.
    1. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32(6):1119–31.
    1. Korytkowski MT, Salata RJ, Koerbel GL, Selzer F, Karslioglu E, Idriss AM, et al. Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial. Diabetes Care. 2009;32(4):594–6.
    1. Datta S, Qaadir A, Villanueva G, Baldwin D. Once-daily insulin glargine versus 6-hour sliding scale regular insulin for control of hyperglycemia after a bariatric surgical procedure: a randomized clinical trial. Endocr Pract. 2007;13(3):225–31.
    1. Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, et al. 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.
    1. Baldwin D, Villanueva G, McNutt R, Bhatnagar S. Eliminating inpatient sliding-scale insulin: a reeducation project with medical house staff. Diabetes Care. 2005;28(5):1008–11.
    1. American Diabetes Association. Summary of revisions to the 2011 clinical practice recommendations. Diabetes Care. 2011;34(Suppl 1):S3.
    1. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009;94(3):709–28.
    1. Ena J, Casan R, Lozano T, Leach A, Algado JT, Navarro-Diaz FJ. Long-term improvements in insulin prescribing habits and glycaemic control in medical inpatients associated with the introduction of a standardized educational approach. Diabetes Res Clin Pract. 2009;85(2):159–65.
    1. Desimone ME, Blank GE, Virji M, Donihi A, DiNardo M, Simak DM, et al. Effect of an educational Inpatient Diabetes Management Program on medical resident knowledge and measures of glycemic control: a randomized controlled trial. Endocr Pract. 2012;18(2):238–49.
    1. Hsia E, Draznin B. Intensive control of diabetes in the hospital: why, how, and what is in the future. J Diabetes Sci Technol. 2011;5(6):1596–601.
    1. DeFronzo RA, Stonehouse AH, Han J, Wintle ME. Relationship of baseline HbA1c and efficacy of current glucose-lowering therapies: a meta-analysis of randomized clinical trials. Diabet Med. 2010;27(3):309–17.
    1. Umpierrez GE, Hor T, Smiley D, Temponi A, Umpierrez D, Ceron M, et al. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009;94(2):564–9.

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