Comparative effectiveness and safety of a pharmacist-managed protocol for the transition from intravenous to subcutaneous insulin
JACCP Journal of the American College of Clinical Pharmacy
; 6(5):474-480, 2023.
Artículo
en Inglés
| EMBASE | ID: covidwho-20235934
ABSTRACT
Purpose:
To evaluate the effectiveness and safety of a pharmacist-managed protocol for transitioning critically ill patients from intravenous (iv) to subcutaneous insulin compared with a provider-managed process. Method(s) This single-center, retrospective, observational study included patients admitted to the medical or surgical/trauma intensive care unit who received a continuous infusion of iv insulin from January 2019 to April 2021. Patients were excluded if they were less than 18 years of age, pregnant, incarcerated, or received iv insulin for the diagnosis of diabetic ketoacidosis, hyperglycemic hyperosmolar state, calcium channel blocker or beta blocker overdose, or hypertriglyceridemia. The primary outcome was the percentage of blood glucose (BG) concentrations within the target range of 70-150 mg/dL from 0 to 48 h following transition to subcutaneous insulin. Secondary outcomes included percentage of BG concentrations within goal range following transition at 0-12 h and 12-24 h, incidence of hypo- and hyperglycemia, and percentage of patients requiring dose adjustments after initial transition. Result(s) A total of 110 unique patients were included with 70 patients in the provider-managed group and 40 patients in the pharmacist-managed group. On average, pharmacists transitioned patients to 63% basal insulin based on their 24-h total day dose of insulin. The pharmacist-managed group achieved glycemic control in 53% of transitions at 12 h, 40% at 24 h, and 47% from 0 to 48 h, while the provider group achieved glycemic control in 25% of transitions at 12 h, 12% at 24 h, and 18% from 0 to 48 h (p < 0.001 for all time points). As for safety end points, the pharmacist-managed group demonstrated lower rates of hypoglycemia (p = 0.001), severe hypoglycemia (p = 0.332), hyperglycemia (p < 0.001), and severe hyperglycemia (p < 0.001) compared with the provider-managed group. Conclusion(s) Pharmacists can effectively and safely transition critically ill patients from iv to subcutaneous insulin utilizing a standardized protocol.Copyright © 2023 Pharmacotherapy Publications, Inc.
glycemic control; hyperglycemia; hypoglycemia; adult; article; clinical protocol; comparative effectiveness; controlled study; coronavirus disease 2019; critically ill patient; diabetes mellitus/dt [Drug Therapy]; drug efficacy; drug safety; female; glucose blood level; hospital admission; human; hyperglycemia/si [Side Effect]; hypoglycemia/si [Side Effect]; insulin treatment; intensive care; invasive ventilation; major clinical study; male; observational study; patient safety; peripheral edema; pharmacist; retrospective study; single blind procedure; surgery; transitional care; corticosteroid; glucose/ec [Endogenous Compound]; hemoglobin A1c/ec [Endogenous Compound]; hypertensive factor; isophane insulin/ae [Adverse Drug Reaction]; isophane insulin/dt [Drug Therapy]; isophane insulin/iv [Intravenous Drug Administration]; isophane insulin/sc [Subcutaneous Drug Administration]
Texto completo:
Disponible
Colección:
Bases de datos de organismos internacionales
Base de datos:
EMBASE
Tipo de estudio:
Estudio experimental
/
Estudio observacional
/
Estudio pronóstico
Idioma:
Inglés
Revista:
JACCP Journal of the American College of Clinical Pharmacy
Año:
2023
Tipo del documento:
Artículo
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