Impact of structured insulin order sets on inpatient hypoglycemia and glycemic control
Open accessAbstract
Objective: In hospitalized patients, glycemic excursions outside recommended glycemic targets have been associated with increased morbidity and mortality. Despite recommendations to avoid use of correctional insulin alone for managing hyperglycemia, this approach remains common. We performed a quality improvement project aimed at both reducing hypoglycemic events and promoting increased use of basal insulin by updating our insulin order sets to reflect clinical practice guideline recommendations. Methods: Brooke Army Medical Center correctional insulin order sets were modified to reflect higher treatment thresholds and targets, and a basal insulin order was added with a recommended weight-based starting dose. Pre- and postintervention analyses were performed. Patients were included if they were prescribed subcutaneous insulin during their hospital stay. The following outcomes were measured: ( 1 ) glucose levels, and ( 2 ) prescriptions for basal insulin. Results: A significant reduction in hypoglycemia events was noted following the intervention (glucose 180 mg/dL) remained unchanged. Conclusion: The alteration in insulin order set parameters resulted in a significant reduction in hypoglycemia without significant increases in hyperglycemia. Although basal insulin use increased, optimal dosing recommendations were not often utilized. Further interventions are necessary to reduce hyperglycemia. Abbreviations: CPOE = computerized provider order entry; EMR = electronic medical re…
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High-quality hospital care for diabetes requires clear and actionable standards for care delivery, which are best implemented using structured order sets with computerized provider order entry (CPOE) as well as quality improvement strategies for process improvement.
“High-quality hospital care for diabetes requires clear and actionable standards for care delivery, which are best implemented using structured order sets with computerized provider order entry (CPOE) as well as quality improvement strategies for process improvement (9).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [9]
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16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s016 · Cited by 80 · see citing works
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“Updating insulin order sets to match current clinical guidelines can lead to significant reductions in inpatient hypoglycemia events without increasing hyperglycemia [44].”
BackgroundKensara, R., Ismail, S., Aseeri, M. A., Hasan, H., AlRahimi, J. S., Zarif, H., & Elkhansa, S. (2023) · Cardiovascular endocrinology & metabolism · doi:10.1097/xce.0000000000000296
“However, all of these studies have failed to reach the target random BGL with modest improvement in mean random BGL [16,17].”
BackgroundMethodResultInfluential
- Authors
- Kravchenko, M. I., Tate, J. M., Clerc, P. G., Forbes, W. L., Gettle, M. C., Wardian, J. L., & Colburn, J. A.
- Affiliations
- Brooke Army Medical Center (US)
- Wilford Hall Ambulatory Surgical Center (US)
- Corresponding author
- Kravchenko, Maria I.
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 26
- Issue
- 5
- Pages
- 523-528
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W3002711553
- Cited by
- 13
- References
- 28
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 3
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- DigitalCommons@UNMC (submittedVersion, public-domain)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- hypoglycemia, glycemic control, basal insulin, hyperglycemia, hospitalized patients, computerized physician order entry, guideline implementation, sliding scale insulin
- MeSH terms
- Blood Glucose, Humans, Hypoglycemia, Hypoglycemic Agents, Inpatients, Insulin, Insulin, Regular, Human
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