Evaluation of insulin therapy in non-critical diabetic patients admitted to a university hospital
DOI:
https://doi.org/10.33448/rsd-v13i10.47183Keywords:
Diabetes Mellitus; Inpatients; Pharmacological treatment; Patient safety.Abstract
Hyperglycemia is a common occurrence in the hospital environment and is associated with negative outcomes. Diabetes Mellitus has a high prevalence among hospitalized patients, and the management of hyperglycemia in the hospital environment for these patients differs from outpatient management. The use of sliding scale as isolated therapy in patients with persistent hyperglycemia is contraindicated; however, many hospitals use this scheme due to its ease. The study aimed to describe and group the different insulin regimens used in the hospital by diabetic patients, profile these patients, identify episodes of hyperglycemia and hypoglycemia and quantitatively evaluate the presence of capillary blood glucose data in the electronic medical record. A retrospective observational research was carried out in a university hospital that collected data for four months and selected all diabetic patients admitted to the neurological, infectious, medical and long-stay clinics. Some of the results obtained showed that: the most prevalent comorbidity, in addition to diabetes, was high blood pressure; the most frequent reason for hospitalization was stroke; the main regimen initially prescribed for patients was the sliding scale; the occurrence of hypoglycemia was identified in 13 patients and the average number of tests performed and registered in the electronic system compared to the prescribed number of blood glucose tests was 84.4%. This study contributed to a better understanding of how insulin treatment is carried out for diabetic patients in the hospital.
References
Akhtar, S. T., Mahmood, K., Naqvi, I. H., & Vaswani, A. S. (2014). Inpatient management of type 2 diabetes mellitus: Does choice of insulin regimen really matter? Pakistan Journal of Medical Sciences, 30(4). https://doi.org/10.12669/pjms.304.4920
Cely, C., Arora, P., Quartin, A., Kett, D., & Schein, R. (2004). Relationship of Baseline Glucose Homeostasis to Hyperglycemia During Medical Critical Illness. Chest, 126(3), 879–887.
Cheung, N. W., Li, S., Ma, G., & Crampton, R. (2008). The relationship between admission blood glucose levels and hospital mortality. Diabetologia, 51(6), 952–955. https://doi.org/10.1007/s00125-008-1001-4
Coltri, V. M., & Silva, R. H. (2019). Prontuário do paciente: Comentários à Lei No 13.787/2018. Rev Bras Odontol Leg RBOL, 6(2), 89–105. http://www.portalabol.com.br/rbol
Diabetes Care in the Hospital: Standards of Care in Diabetes— 2024. (2024). Diabetes Care, 47, 295–306. https://doi.org/10.2337/dc24-S016
Diretrizes da Sociedade Brasileira de diabetes. (2020). Sociedade Brasileira de Diabetes, 437–463.
Donihi, A. C. (2017). Practical Recommendations for Transitioning Patients with Type 2 Diabetes from Hospital to Home. Current Diabetes Reports, 17(7). https://doi.org/10.1007/s11892-017-0876-1
Healy, S. J., Nagaraja, H. N., Alwan, D., & Dungan, K. M. (2017). Prevalence, predictors, and outcomes of steroid-induced hyperglycemia in hospitalized patients with hematologic malignancies. Endocrine, 56(1), 90–97. https://doi.org/10.1007/s12020-016-1220-2
Korytkowski, M. T., Muniyappa, R., Antinori-Lent, K., Donihi, A. C., Drincic, A. T., Hirsch, I. B., Luger, A., McDonnell, M. E., Murad, M. H., Nielsen, C., Pegg, C., Rushakoff, R. J., Santesso, N., & Umpierrez, G. E. (2022). Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 107(8), 2101–2128. https://doi.org/10.1210/clinem/dgac278
Kulasa, K., Juang, P. (2017). How Low Can You Go? Reducing Rates of Hypoglycemia in the Non-critical Care Hospital Setting. Current Diabetes Reports, 17(9). https://doi.org/10.1007/s11892-017-0902-3
Modenesi, R. F., Mesquita, E. T., Pena, F. M., Robson Mendes De Souza, N., Da, J., Soares, S., & Cardozo De Faria, C. A. (2010). Hiperglicemia de Estresse na Síndrome Coronariana Aguda: controle e importância prognóstica. Rev Bras Cardiol, 23(2), 178–184.
Moreira, E. D., Silveira, P. C. B., Neves, R. C. S., Souza, C., Nunes, Z. O., & Almeida, M. D. C. C. (2013). Glycemic control and diabetes management in hospitalized patients in Brazil. Diabetology and Metabolic Syndrome, 5(1). https://doi.org/10.1186/1758-5996-5-62
Moura, F., Salles, J. E. N., Valente, F., Almeida-Pititto, B. de, Fonseca, R. M. C., Cavalcanti, S., & Bertoluci, M. (2023). Abordagem do paciente idoso com diabetes mellitus. Em Diretriz da Sociedade Brasileira de Diabetes. Conectando Pessoas. https://doi.org/10.29327/5238993.2023-3
Mullugeta, Y., Chawla, R., Kebede, T., & Worku, Y. (2012). Dyslipidemia associated with poor glycemic control in type 2 diabetes mellitus and the protective effect of metformin supplementation. Indian Journal of Clinical Biochemistry, 27(4), 363–369. https://doi.org/10.1007/s12291-012-0225-8
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Santa Maria/RS. Ed. UAB/NTE/UFSM.
Pinheiro, D. da S., Costa, C. D. D., Rocha, C. R. R., Mundim, C. A., Reis, A. A. da S., & Ghedini, P. C. (2012). Avaliação do nível de controle glicêmico dos pacientes diabéticos tipo 2 atendidos em um Hospital Universitário. Revista da Universidade Vale do Rio Verde, 10(2), 03–11. https://doi.org/10.5892/ruvrv.2012.102.0311
Posicionamento Oficial SBD no 03/2015. Controle da glicemia no paciente hospitalizado (2015).
Santana, M. M. S., Santos, J. A. da S., & Pereira, F. de A. (2022). Perfil clínico dos pacientes não críticos portadores de diabetes mellitus hospitalizados nas enfermarias do Hospital Universitário da Universidade Federal de Sergipe. Research, Society and Development, 11(7), e23511729911. https://doi.org/10.33448/rsd-v11i7.29911
Silva Filho, R. L. da, Albuquerque, L., Cavalcanti, S., Tambascia, M., Valente, F., & Bertoluci, M. (2022). Tratamento farmacológico da hiperglicemia no DM2. Em Diretriz Oficial da Sociedade Brasileira de Diabetes. Conectando Pessoas. https://doi.org/10.29327/557753.2022-10
Silvio E Inzucchi, M. (2024, agosto 5). Management of diabetes mellitus in hospitalized patients. UptoDate. https://www.uptodate.com/contents/management-of-diabetes-mellitus-in-hospitalized-patients
Thayane, M., Freire, P., Andrade, J. M., Nogueira, H., & Veras, H. (2019). Avaliação Glicêmica de Pacientes Diabéticos Atendidos na Estratégia Saúde da Família na Cidade de Assaré-CE. Id on Line Rev. Mult. Psic. V, 13, 221–239. http://idonline.emnuvens.com.br/id
Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002). Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes. The Journal of Clinical Endocrinology & Metabolism, 87(3), 978–981. https://academic.oup.com/jcem/article/87/3/978/2846522
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