Protocol-driven insulin therapy on the medical-surgical wards resulted in better glucose control, as compared to individualized management in patients with diabetic foot ulcers. As a result, shorter hospital stay may be possible.
"This is the first randomized pilot trial to showcase how intensive subcutaneous insulin protocol on medical-surgical wards can help to improve diabetes control," Alicia Leung, MD, at Stroger Hospital of Cook County in Chicago said. "Diabetes clinical pathway applied to routine management of surgical patients on the wards of public hospitals resulted in superior glucose control."
AdvertisementA group of 23 patients with type 2 Diabetes Mellitus were admitted for surgical management of diabetic foot ulcers. Once routine medical consultation for preoperative evaluation of high glucose was requested, patients were randomly assigned to a medical consult physician providing individualized glycemic management or medical consult physician trained in protocol-driven subcutaneous insulin therapy twice a day.
"Those patients that received the protocol-driven insulin therapy were in the hospital roughly 2.5 days less than those who received the individualized glycemic management, discharge decisions being made by a surgical team based on wound healing and regardless of glucose control", Dr. Leung said. "This clinically significant difference eventually supported implementation of hospital-wide subcutaneous insulin protocol at Stroger Hospital, limiting the size of our study - thus we were able to show only a marginal statistical significance. Optimal glucose control is known to improve wound healing and also make diabetic patients less susceptible to bacterial infections."
"Our study shows that protocol-driven insulin therapy results in a better glycemic outcome, improving the quality of care and achieving standard of care goals," Dr. Leung said.
"Endocrinology expertise is important in implementing and trouble-shooting insulin protocol, identifying patients that do not fit standard care," Dr. Jurado, currently a hospitalist at Saint Lukes Hospital in Jacksonville, FL, said. "However, hyperglycemia being the fourth most common co-morbid condition in the hospital, clinical pathways for glucose management can be successfully delivered by hospitalists and house staff physicians."