Original ArticleManagement of Inpatient Hyperglycemia: Assessing Perceptions and Barriers to Care Among Resident Physicians
Section snippets
INTRODUCTION
Hyperglycemia in hospitalized patients is associated with worse outcomes (such as longer lengths of stay and higher mortality) in comparison with outcomes for patients without elevated blood glucose levels 1., 2.. Both randomized controlled trials and observational studies, however, have shown that outcomes can be improved with aggressive management of hyperglycemia 1., 2.. Consequently, glucose targets have been proposed for critically and non-critically ill patients in the hospital (2). In
Setting
Our academic teaching hospital is a 200-bed tertiarycare facility located in metropolitan Phoenix, Arizona. All adult general medical and surgical specialties are represented, including transplantation services (kidney, liver, pancreas, and, most recently, heart), a level 2 trauma center, and an inpatient rehabilitation unit. Various types of practitioners provide patient care in our hospital, including postgraduate trainees (residents), medical school faculty, physician assistants, and
Respondent Demographics
Responses were obtained from 52 of 70 residents (74% response). The mean age of the respondents was 31 years, 48% were men, 37% were in their first year of residency training, and 33% were 2005 graduates of medical schools. The residents represented the following departments: 44% internal medicine (N = 23), 25% general surgery (N = 13), 17% family medicine (N = 9), and 14% other (for example, transitional year, urology, or neurology; N = 7).
Perception About the Inpatient Burden of Diabetes
When the residents were asked to estimate the
DISCUSSION
Before hospitals can develop high-quality improvement and educational programs focused on inpatient hyperglycemia, they will need more insight into how their health care practitioners view the importance of inpatient glycemic control and what problems must be overcome in its successful treatment. Beliefs about diabetes have been explored in the past 10., 11., 12., but reported data specific to the inpatient setting are lacking. As part of a planned educational effort directed at enhancing
CONCLUSION
Despite the noted limitations, the results from this pilot study have already enabled us to focus our educational efforts to improve inpatient glycemic control. Most residents acknowledge the importance of good inpatient glucose control and have set target glucose ranges consistent with existing guidelines. Although these concepts should still be reinforced, our educational efforts must review therapeutic options, emphasize appropriate use of insulin in hospitalized patients, and focus on
DISCLOSURE
The authors have no conflicts of interest to disclose.
ACKNOWLEDGMENT
We thank Frederick D. Edwards, MD, Residency Program Director for Family Medicine; Richard J. Gray, MD, Residency Program Director for General Surgery; and Keith J. Cannon, MD, Residency Program Director for Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, for their help in administering the surveys. We also thank Laurie Wilshusen, MA, marketing consultant, Department of Public Affairs, Mayo Clinic Rochester, Rochester, Minnesota, for valuable input on the questionnaire. Editing,
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