2.50
Hdl Handle:
http://hdl.handle.net/10755/164369
Category:
Abstract
Type:
Presentation
Title:
Acute Care Diabetes Management in the Morning: Do We Need a Change?
Author(s):
Cohen, Linda S.
Author Details:
Linda S. Cohen, RN, MSN, MPH, CDE, Downstate Medical Center, Brooklyn, New York, USA, email: nacnsorg@nacns.org
Abstract:
Problem and significance: Hyperglycemia can increase morbidity and mortality in hospitalized patients. It is known that controlling hyperglycemia reduces both morbidity and mortality during hospitalization while improving short, intermediate and long-term outcomes. Purpose: This study assessed the current practice of morning diabetes management in a university hospital by noting specific times of glucose monitoring, insulin administration and, delivery of breakfast to determine whether these variables effected glucose control and patient safety. Specifically, we sought to determine whether timing of insulin administration before breakfast related to development of pre-lunch hyperglycemia. Overall questions: Does current diabetes management in terms of intervals between glucose monitoring, time of insulin administration and the time of breakfast impact on subsequent adverse outcomes? Hypotheses: 1) The longer the interval between blood glucose monitoring and insulin injection, the more likely the patient will have an adverse outcome. 2) The longer the interval between insulin injection in the morning and starting breakfast, the more likely the patient will have an adverse outcome. 3) The longer the interval between blood glucose testing and breakfast, the more likely the patient will have an adverse outcome. Design and methods: A quantitative, descriptive, correlational, non-experimental, prospective design. The practice of morning diabetes management was studied as it was practiced. This study explored relationships among the variables of interest. Setting and participants: A non-probability convenience sample of 40 diabetic hospitalized adults in a 376-bed tertiary, urban, academic medical center. Study results/outcomes: 40 adult diabetic patients were divided into either group 1 (breakfast <45 minutes after receiving insulin) or group 2 (breakfast >45 minutes after receiving insulin). Data collected included the interval between: blood glucose monitoring and insulin administration, insulin administration and start of breakfast and blood glucose monitoring and breakfast. Main outcome was pre-lunch glucose; a value <180 mg/dL was deemed acceptable. Mean pre-lunch glucose value for group 2 was significantly higher than group 1 (243 +/- 90 vs. 172 +/- 93, p=0.033). Eighty percent (80%) of patients in group 2 had pre-lunch glucose >180 mg/dL, and 20% had a pre-lunch glucose of <180 mg/dL, whereas 43% of patients in group 1 had glucose values >180 and 57% had glucose values <180, p=0.026. Logistical regression analysis showed a 5.3 times higher risk of having a pre-lunch blood glucose value >180 mg/dL in patients who had breakfast >45 minutes after receiving insulin as compared to those who received insulin <45 minutes prior to breakfast (RR=5.3{95% CI 1.2-25, p=0.031}). Other variables collected were not associated with pre-lunch hyperglycemia. Conclusions/implications for nursing: Feeding breakfast longer than 45 minutes after insulin administration induces unacceptable blood sugar control in hospitalized diabetic patients. Proper linkage of feeding with insulin administration may improve glycemic control in hospitalized patients, necessitating a change in how diabetic care is delivered. Possible alterations in sequential care include synchronizing nursing scheduled monitoring and insulin administration to the time of food delivery. The clinical nurse specialist is well suited to work with the various health care practitioners, hospital systems and patients to design, implement and evaluate necessary changes that can improve quality of care and patient safety. Problem and significance: Hyperglycemia can increase morbidity and mortality in hospitalized patients. It is known that controlling hyperglycemia reduces both morbidity and mortality during hospitalization while improving short, intermediate and long-term outcomes.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2005
Conference Name:
CNS Leadership: Navigating the Healthcare Environment Toward Excellence
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Orlando, Florida, USA
Description:
Conference theme: CNS Leadership: Navigating the Healthcare Environment Toward Excellence, held on March 9�12, 2005 in Orlando, Florida, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleAcute Care Diabetes Management in the Morning: Do We Need a Change?en_GB
dc.contributor.authorCohen, Linda S.en_US
dc.author.detailsLinda S. Cohen, RN, MSN, MPH, CDE, Downstate Medical Center, Brooklyn, New York, USA, email: nacnsorg@nacns.orgen_US
dc.identifier.urihttp://hdl.handle.net/10755/164369-
dc.description.abstractProblem and significance: Hyperglycemia can increase morbidity and mortality in hospitalized patients. It is known that controlling hyperglycemia reduces both morbidity and mortality during hospitalization while improving short, intermediate and long-term outcomes. Purpose: This study assessed the current practice of morning diabetes management in a university hospital by noting specific times of glucose monitoring, insulin administration and, delivery of breakfast to determine whether these variables effected glucose control and patient safety. Specifically, we sought to determine whether timing of insulin administration before breakfast related to development of pre-lunch hyperglycemia. Overall questions: Does current diabetes management in terms of intervals between glucose monitoring, time of insulin administration and the time of breakfast impact on subsequent adverse outcomes? Hypotheses: 1) The longer the interval between blood glucose monitoring and insulin injection, the more likely the patient will have an adverse outcome. 2) The longer the interval between insulin injection in the morning and starting breakfast, the more likely the patient will have an adverse outcome. 3) The longer the interval between blood glucose testing and breakfast, the more likely the patient will have an adverse outcome. Design and methods: A quantitative, descriptive, correlational, non-experimental, prospective design. The practice of morning diabetes management was studied as it was practiced. This study explored relationships among the variables of interest. Setting and participants: A non-probability convenience sample of 40 diabetic hospitalized adults in a 376-bed tertiary, urban, academic medical center. Study results/outcomes: 40 adult diabetic patients were divided into either group 1 (breakfast <45 minutes after receiving insulin) or group 2 (breakfast >45 minutes after receiving insulin). Data collected included the interval between: blood glucose monitoring and insulin administration, insulin administration and start of breakfast and blood glucose monitoring and breakfast. Main outcome was pre-lunch glucose; a value <180 mg/dL was deemed acceptable. Mean pre-lunch glucose value for group 2 was significantly higher than group 1 (243 +/- 90 vs. 172 +/- 93, p=0.033). Eighty percent (80%) of patients in group 2 had pre-lunch glucose >180 mg/dL, and 20% had a pre-lunch glucose of <180 mg/dL, whereas 43% of patients in group 1 had glucose values >180 and 57% had glucose values <180, p=0.026. Logistical regression analysis showed a 5.3 times higher risk of having a pre-lunch blood glucose value >180 mg/dL in patients who had breakfast >45 minutes after receiving insulin as compared to those who received insulin <45 minutes prior to breakfast (RR=5.3{95% CI 1.2-25, p=0.031}). Other variables collected were not associated with pre-lunch hyperglycemia. Conclusions/implications for nursing: Feeding breakfast longer than 45 minutes after insulin administration induces unacceptable blood sugar control in hospitalized diabetic patients. Proper linkage of feeding with insulin administration may improve glycemic control in hospitalized patients, necessitating a change in how diabetic care is delivered. Possible alterations in sequential care include synchronizing nursing scheduled monitoring and insulin administration to the time of food delivery. The clinical nurse specialist is well suited to work with the various health care practitioners, hospital systems and patients to design, implement and evaluate necessary changes that can improve quality of care and patient safety. Problem and significance: Hyperglycemia can increase morbidity and mortality in hospitalized patients. It is known that controlling hyperglycemia reduces both morbidity and mortality during hospitalization while improving short, intermediate and long-term outcomes.en_GB
dc.date.available2011-10-27T11:47:07Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:47:07Z-
dc.conference.date2005en_US
dc.conference.nameCNS Leadership: Navigating the Healthcare Environment Toward Excellenceen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationOrlando, Florida, USAen_US
dc.descriptionConference theme: CNS Leadership: Navigating the Healthcare Environment Toward Excellence, held on March 9�12, 2005 in Orlando, Florida, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.