Basal-Bolus Insulin Protocols Enter the Computer Age
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Diabetes affects approximately one quarter of all hospitalized patients. Poor inpatient glycemic control has been associated with increased risk for multiple adverse events including surgical site infections, prolonged hospital length of stay, and mortality. Inpatient glycemic control protocols based on physiologic basal-bolus insulin regimens have been shown to improve glycemia and clinical outcomes and are recommended by the American Diabetes Association, the American Association of Clinical Endocrinologists, and the Society of Hospital Medicine for inpatient glycemic management of noncritically ill patients. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act will catalyze widespread computerized medication order entry implementation over the next few years. Here, we focus on the noncritical care setting and review the background on inpatient glycemic management as it pertains to computerized order entry, the translation and efficacy of computerizing glycemic control protocols, and the barriers to computerizing glycemic protocols.
KeywordsBasal-bolus insulin protocols Inpatient glycemic management Computerized order entry Electronic decision support Standardized insulin order sets Hyperglycemia
N.J. Wei is supported by an NIDDK training grant (T32 DK007028-36). D.J. Wexler is supported by an NIDDK Career Development Award (K23 DK 080 228).
No potential conflicts of interest relevant to this article were reported.
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