Glycemic Control in Medical Inpatients with Type 2 Diabetes Mellitus Receiving Basal Bolus Insulin Versus Sliding Scale Insulin

Emery, Joyce Elaine

Saturday, 29 October 2011

Joyce Elaine Emery, MSN, RN, CDE
Nursing Administration, Covenant Health System, Lubbock, TX

Learning Objective 1: The learner will be able to identify the effects of poor diabetic control on patients hospitalized with known or unknown diagnosis of type 2 diabetes.

Learning Objective 2: The learner will be able to verbalize the importance of mimicking the normal physiologic response of the pancreas in treating hyperglycemia.

Purpose: Despite its broad acceptance, evidence supporting the effectiveness of sliding-scale insulin (SSI) is lacking. Professional organizations whose position statements promote strict glycemic control in patients with diabetes mellitus acknowledge the questionable effectiveness of conventional SSI regimens, particularly when not used in combination with basal insulin (Golightly et al., 2006; Schnipper et al., 2006). The purpose of this quantitative study is to compare the efficacy and safety of a basal-bolus insulin regimen with SSI in patients with type 2 diabetes. Poor glycemic control in hospitalized patients is strongly associated with undesirable outcomes for a variety of conditions, including pneumonia, cancer chemotherapy, renal transplant, and postsurgical wounds. Hyperglycemia also induces dehydration, fluid and electrolyte imbalance, gastric motility problems, and venous thromboembolism formation (Maynard et al, 2009; Arif et al., 2010). Improvements in glycemic control utilizing basal bolus insulin over the use of SSI alone were found in Shaw’s (2009) systematic review.

Methods: Hypothesis #1: Patients placed on Basal Bolus SQ insulin therapy for glycemic control will have decreased incidence of hypoglycemic episodes. Hypothesis #2: Patients placed on Basal Bolus SQ insulin therapy for glycemic control will have decreased incidence of hyperglycemia. Hypothesis #3: Patients placed on Basal Bolus SQ insulin will have decreased length of stay. Carper’s Four Patterns of Knowing: Empirics, Ethics, Personal, and Aesthetics theories guiding evidence-based practice provide the theoretical framework for this study (Carper, 1978; Fawcett et al., 2001). Patients’ demographic data, laboratory and point-of-care glucose meter results will be recorded on a data collection tool, from a review of the patient’s electronic medical record. Based on data results, a change to policy and procedure for glycemic control will be proposed to the Medical Committee and Nursing Administration of Covenant Health System.

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