Pilot and Revision of a Basal-Bolus Dosing Guideline for the Management of Hyperglycemia in Noncritically Ill Adult Patients.

ABSTRACT

The use of basal-bolus insulin (BBI) regimens for the treatment of inpatient hyperglycemia has become standard of care. The purpose of this study was to develop and evaluate a newly piloted dosing guideline and utilize the results to adjust it prior to its implementation hospital-wide. This was an institutional review board approved, prospective, and multiphase study. An interdisciplinary team was developed and created a dosing guideline, which was followed by a 3-month, single-unit pilot of the guideline in noncritically ill adult patients. The resulting data were used to revise the guideline. Forty-three patients were included. There was a significant decrease in median blood glucose (BG) with use of the guideline (219 mg/dL [162-281] vs 190 mg/dL [136-246], P < .05) in patients not utilizing it. There was also a significant increase in the number of values within the target range of 70 to 180 mg/dL (30.2% vs 41.4%, P < .05). Moreover, there was comparable hypoglycemia before and after the intervention (1.6% vs 2.4%, P = .51). Based on these results, the dosing factor used for the total daily dose of insulin was increased in certain populations. Use of a BBI dosing guideline is safe and effective in decreasing BG values in noncritically ill patients at our institution.