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Diabetes Educ. 2007 May-Jun;33(3):483-92.

Inpatient diabetes management: examining morning practice in an acute care setting.

Author information

1
The Department of Nursing Services, State University of New York Downstate Medical Center, Brooklyn (Ms Cohen),
2
College of Nursing Graduate Programs, State University of New York Downstate Medical Center, Brooklyn (Dr Sedhom)
3
Department of Medicine, State University of New York Downstate Medical Center, Brooklyn (Dr Salifu, Dr Friedman)

Abstract

PURPOSE:

Morning diabetes management in an inpatient acute care facility was examined.

METHODS:

A descriptive, nonexperimental research design was used to study the effect of the following variables on patients' prelunch blood glucose: duration of time between (1) blood glucose monitoring and insulin administration, (2) insulin administration and breakfast, and (3) blood glucose monitoring and breakfast. A nonprobability convenience sample was used to examine 40 adults with diabetes who were hospitalized in an urban, academic medical center.

RESULTS:

The chi2 test and measurements of central tendency were used for statistical analysis. The mean interval of time between (1) blood glucose monitoring and insulin administration was 93 minutes+/-52.82, (2) blood glucose monitoring and breakfast was 121+/-47 minutes, and (3) insulin administration and breakfast was 73+/-37.06 minutes. Insulin was administered in 28% of patients<45 minutes before breakfast, whereas in 39% and 33%, it was administered between 46 and 90 minutes and >90 minutes prior to breakfast, respectively. There was a statistically significant difference (P=.033) between mean prelunch glucose levels for subjects who received insulin>45 minutes before breakfast and mean glucose levels for those who received insulin<45 minutes before breakfast. Eighty percent of patients whose breakfast was >45 minutes following insulin had prelunch glucose values of >180 mg/dL (10 mmol/L) versus 20%<180 mg/dL (10 mmol/L). Of those whose breakfast was <45 minutes before insulin, 43% had blood glucose levels>180 mg/dL, and 57% had blood glucose<180 mg/dL (P=.026). A logistical regression model revealed that patients had a 5.3 times higher risk of having a prelunch blood glucose level>180 mg/dL when their breakfast time was >45 minutes after receiving insulin as compared to those whose insulin was given<45 minutes before breakfast (relative risk, 5.3; 95% confidence interval, 1.2-25; P=.031).

CONCLUSION:

Current practice suggests patients are at a higher risk of prelunch hyperglycemia, and multiple opportunities exist to improve care for the inpatient with diabetes.

PMID:
17570879
DOI:
10.1177/0145721707301351
[Indexed for MEDLINE]

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