The Inpatient Diabetes Program was created to address the management of inpatient hyperglycemia at Boston Medical Center. Our group includes endocrinologists, nurse practitioners, and endocrinology fellows. Our goal is to provide expertise to assist providers in the care of patients with diabetes and hyperglycemia during acute illness and in the transition out of the hospital.
In 2005, a comprehensive Inpatient Diabetes Management Service has been providing intensive management of diabetes in the the inpatient medical floors and intensive care units. The Adult Inpatient Diabetes Program is designed to meet current national standards for glycemic control in patients hospitalized at Boston Medical Center. The program recognizes that, with the rising prevalence of insulin resistance due to conditions such as obesity and the metabolic syndrome, the number of inpatients with known diabetes, as well as unknown diabetes, is expected to rise. Moreover, expert opinion and clinical research have identified hyperglycemia as a factor that increases length of stay, hospital complications, and even inpatient mortality. Dr. Alexanian directs the inpatient diabetes program and a second inpatient diabetes nurse practitioner service focuses primarily on patient education and transition from hospital discharge to the outpatient clinics. The central goals of the program include the following:
In all Critical Care Units:
- Support the safe and effective use of one insulin infusion protocol in all ICUs
- Directly assist with glycemic control in the CCU
- Develop a “transition off drip” protocol for use in the BMC electronic order entry system
- Develop insulin protocols for special populations: e.g. high dose steroids
- Develop a hospital-wide critical pathway for Hyperglycemic Crisis (DKA, HHS)
On all Medical, Surgical, Ob/Gyn Units:
- Promote patient-appropriate insulin prescribing in the hospital
- Improve glycemic control on the floors (fbg 80-110, pp < +180)
- Dedicated consultation service for education and management of patients with diabetes
- Advocation for patients with diabetes, especially those using special therapies (e.g. pump patients, new insulins)
- Improve inpatient transition to home & to their primary physician
- Develop “New Onset Diabetes Pathway” for use in BMC’s electronic order entry system
An essential element of the program is the education of nurses, physicians and patients. A major source of the necessary education comes from the members of the newly-formed Endocrine subcommittee of the Pharmacy and Therapeutics hospital committee. This is a multidisciplinary group of health care professionals led by Dr. Alexanian with members from the department of pharmacy, nursing, information technology, the Internal Medicine Residency and the Section of Endocrinology. The initial group was founded in the Fall of 2004 and made official in 2005 to reach the goal of safe and effective insulin therapy for all inpatients with hyperglycemia.
Lastly, in collaboration with BMC’s pharmacy and information technology, a plan is in place to continuously evaluate the diabetes-related clinical outcomes in our patient population. The data from this ongoing project will be invaluable for both internal and general knowledge about the management of patients with diabetes and hyperglycemia at Boston Medical Center.
This team will directly manage all patients with hyperglycemia in all intensive care units of the BMC (medical and surgical) and to transition to the floors to improve medical outcome. The diabetes service has been working with the high-risk prenatal obstetrics group at BMC to manage pregnant women with diabetes mellitus.