Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: effect of structured subcutaneous insulin orders and an insulin management algorithm.

BACKGROUND: Structured subcutaneous insulin order sets and insulin protocols are widely advocated. The intervention effects are not well reported. OBJECTIVE: Assess the impact of these interventions on insulin use patterns, hypoglycemia, and glycemic control. DESIGN: Prospective observational. SETTING: 400-bed academic center. PATIENTS: Adult non-critical care inpatients with diabetes or hyperglycemia and point-of-care (POC) glucose testing. INTERVENTIONS: Structured insulin orders, insulin management algorithm. MEASUREMENTS: Percent of insulin orders with basal insulin. Percent uncontrolled patient-stays (day-weighted mean glucose >or=180 mg/dL) and uncontrolled patient-days (patient-day mean glucose >or=180 mg/dL). Percent of monitored patient-days and patient-stays with hypoglycemia (glucose