Implantación de un programa para el manejo de la hiperglucemia en la hospitalización con la incorporación de la enfermera consultora / Implementation of an inpatient hyperglycemia management program incorporating a nurse consultant

INTRODUCCIÓN Y OBJETIVOS: La eficacia y seguridad de los protocolos de manejo de la hiperglucemia hospitalaria con pautas basal-bolo están ampliamente demostradas, pero su implementación es insuficiente. El objetivo del estudio fue valorar la implantación y determinar la eficacia y seguridad de un protocolo de manejo de la hiperglucemia hospitalaria basado en la terapia basal-bolo y la incorporación de una enfermera consultora. MATERIAL Y MÉTODOS: La evaluación se realizó en 10 unidades de hospitalización. Se revisaron retrospectivamente los datos durante la hospitalización y a los 90 días tras el alta de 400 pacientes postimplantación y 200 pacientes preimplantación del protocolo. El grado de satisfacción de los profesionales se valoró mediante un cuestionario a los 12 meses de la implantación. RESULTADOS: La proporción de pacientes con pauta basal-bolo en el ingreso fue superior en el grupo postimplantación (58% frente a 9%, p < 0,001). La media de las glucemias prepandiales y al acostarse durante el ingreso fue menor en el grupo postimplantación (164 ± 41mg/dl frente a 196 ± 50 mg/dl, p < 0,001). La proporción de pacientes con glucemias > 300 mg/dl fue menor (36,3% frente a 50,5%; p < 0,001) y con glucemias < 70 mg/dl fue superior (15% frente a 9%, p = 0,040) en el grupo postimplantación. La adición e intensificación de la insulina fue la principal modificación del tratamiento al alta y se observó reducción significativa de la HbA1c a los 3 meses del alta en la fase postimplantación (p = 0,04). La valoración del protocolo por parte de los profesionales fue de 4,5 en una escala de 1 a 5. CONCLUSIONES: La incorporación de una enfermera consultora experta en diabetes como elemento central del programa de manejo de la hiperglucemia consigue que la mayoría de los pacientes hospitalizados con hiperglucemia reciban tratamiento con una pauta basal-bolo y una mejora del control glucémico durante la hospitalización y tras el alta

BACKGROUND AND AIMS: The efficacy and safety of inpatient hyperglycemia management protocols using basal-bolus regimens have been widely demonstrated, but their implementation is insufficient. The aim of the study was to assess implementation and to establish the efficacy and safety of inpatient hyperglycemia management protocol based on a basal-bolus regimen and the incorporation of a nurse consultant. MATERIAL AND METHODS: Evaluation was performed at 10 hospital units. Data were retrospectively reviewed during hospital stay and 90 days after discharge in 400 patients after protocol implementation and 200 patients before implementation. The degree of satisfaction of professionals was assessed using a questionnaire 12 months after implementation. RESULTS: The proportion of patients with basal-bolus regimens upon admission was higher in the postimplementation group (58% vs. 9%, P < 0.001). Mean pre-prandial and bedtime blood glucose levels during admission were lower in the postimplementation group (164 ± 41 mg/L vs. 196 ± 50 mg/dL, P < 0.001). After implementation, there were less patients with blood glucose levels > 300 mg/dL (36.3% vs. 50.5%, P < 0.001) and more patients with values < 70mg/dL (15% vs. 9%, P = 0.040). Insulin addition and intensification was the main change in treatment at discharge, and a significant HbA1c reduction was seen three months after discharge in the postimplementation phase (P = 0.04). The professionals assigned the protocol a score of 4.5 on a 1 to 5 scale. CONCLUSIONS: Incorporation of a nurse consultant expert in diabetes as key component of a hyperglycemia management program ensures that a majority of patients admitted to hospital for hyperglycemia receive treatment with a basal-bolus regimen and improves blood glucose control during hospital stay and after discharge

Implementation of an inpatient hyperglycemia management program incorporating a nurse consultant. / Implantación de un programa para el manejo de la hiperglucemia en la hospitalización con la incorporación de la enfermera consultora.

BACKGROUND AND AIMS: The efficacy and safety of inpatient hyperglycemia management protocols using basal-bolus regimens have been widely demonstrated, but their implementation is insufficient. The aim of the study was to assess implementation and to establish the efficacy and safety of inpatient hyperglycemia management protocol based on a basal-bolus regimen and the incorporation of a nurse consultant. MATERIAL AND METHODS: Evaluation was performed at 10 hospital units. Data were retrospectively reviewed during hospital stay and 90 days after discharge in 400 patients after protocol implementation and 200 patients before implementation. The degree of satisfaction of professionals was assessed using a questionnaire 12 months after implementation. RESULTS: The proportion of patients with basal-bolus regimens upon admission was higher in the postimplementation group (58% vs. 9%, P<0.001). Mean pre-prandial and bedtime blood glucose levels during admission were lower in the postimplementation group (164±41mg/L vs. 196±50mg/dL, P<0.001). After implementation, there were less patients with blood glucose levels >300mg/dL (36.3% vs. 50.5%, P<0.001) and more patients with values <70mg/dL (15% vs. 9%, P=0.040). Insulin addition and intensification was the main change in treatment at discharge, and a significant HbA1c reduction was seen three months after discharge in the postimplementation phase (P=0.04). The professionals assigned the protocol a score of 4.5 on a 1 to 5 scale. CONCLUSIONS: Incorporation of a nurse consultant expert in diabetes as key component of a hyperglycemia management program ensures that a majority of patients admitted to hospital for hyperglycemia receive treatment with a basal-bolus regimen and improves blood glucose control during hospital stay and after discharge.