Original ArticlePatient Outcomes after Implementation of a Protocol for Inpatient Insulin Pump Therapy
Section snippets
BACKGROUND
The number of patients who use continuous subcutaneous insulin infusion (CSII) by means of an insulin pump for management of diabetes is increasing; thus, the likelihood that these patients will be encountered in the hospital setting is high (1). Recent estimates suggest that more than 220,000 patients in the United States use CSII (1). This increasing trend is likely to continue with the prediction that 40% of patients with type 1 diabetes and 5% of those with type 2 diabetes may eventually
METHODS
This project was approved by the Quality Improvement Review Committee of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Patient Experience
Fifty inpatients (20 female and 30 male patients) were identified as users of CSII in the hospital between December 2004 and August 2006. The mean age of these patients was 49 ± 16 years (range, 21 to 70). The mean hemoglobin A1c was 7.9% ± 1.4% in the 24 patients who had this measurement during their hospital admission. The most frequent reasons for admission were cardiac (chest pain, acute myocardial infarction, or congestive heart failure) (n = 14); gastrointestinal (Crohn disease,
DISCUSSION
We report patient experience and glycemic outcomes in 50 consecutive inpatients treated with CSII after implementation of a standardized IIPP. This quality improvement project for CSII use in the hospital was initiated in response to several misadventures related to pump therapy in our hospital. On the basis of the results in the 50 patients included in this report, we believe that an IIPP is an effective and safe strategy for guiding the use of CSII therapy in the hospital.
Our results are in
CONCLUSION
An IIPP can help standardize the approach for diabetes self-management during periods of hospitalization. An IIPP was used in the majority of patients identified during the time period for this project and continues to be used at our institution as the standard of care for this group of patients. The multidisciplinary development and implementation of the IIPP, appropriate patient selection, nursing education, and support from the IDS were important components that contributed to the success of
DISCLOSURE
The authors have no conflicts of interest to disclose.
ACKNOWLEDGMENT
This work was sponsored by funding from the United States Air Force administered by the United States Army Medical Research Acquisition Activity, Fort Detrick, Maryland, Award Number W81XWH-04-2-0030. Some of this material was presented as a poster at the 67th Scientific Sessions of the American Diabetes Association; June 22-26, 2007; Chicago, Illinois.
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2023, Endocrine PracticeCitation Excerpt :Nonetheless, multiple case series, along with professional society guidelines, indicate that with proper selection criteria and policies in place, patients using outpatient CSII can have their technology safely transitioned into the hospital for continued inpatient use.7-9 Previous studies have shown increased patient satisfaction with the ability to continue use of their preexisting outpatient pump technology during hospitalization.10,11 Furthermore, CGM technologies are not FDA approved for determination of insulin dosing in the inpatient setting.
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Published as a Rapid Electronic Article in Press at http://www.endocrinepractice.org on June 2, 2009. DOI: 10.4158/EP09063.ORR