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Role of Subcutaneous Insulin Management Protocols and Order Sets in Inpatient Diabetes Management

      Diabetes has been reported to be the fourth most common comorbid condition listed in all hospital discharges and, as a result, recent years have seen an increasing interest in the glycemic management of inpatients (
      • Vasa F.
      Systematic strategies for improved outcomes for the hyperglycemic hospitalized patient with diabetes mellitus.
      ). Despite growing evidence that both hyperglycemia and hypoglycemia in hospitalized patients is associated with adverse outcomes, many barriers are routinely encountered in achieving optimal glycemic control in the inpatient population (
      • Clement S.
      • Braithwaite S.S.
      • Magee M.F.
      • et al.
      American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals.
      ,
      • Inzucchi S.E.
      • Bergenstal R.M.
      • Buse J.B.
      • et al.
      American Diabetes Association, European Association for the Study of Diabetes. Management of hyperglycemia in type 2 diabetes, a patient-centered approach: position statement of the American Diabetes Association and the European Association for the Study of Diabetes.
      ,
      • Braithwaite S.S.
      • Magee M.
      • Sharetts J.M.
      • et al.
      Society of Hospital Medicine Glycemic Control Task Force. The case for supporting inpatient glycemic control programs now: the evidence and beyond.
      ). Common obstacles include unanticipated changes in nutritional status (e.g. nil per os [NPO], enteral/parental feeds); the use of medications associated with hyperglycemia (e.g. glucocorticoids) the effects of physiological stress responses on blood glucose levels and the presence of comorbid conditions (e.g. acute or worsening renal function) (
      • Draznin B.
      • Gilden J.
      • Golden S.H.
      • et al.
      Pathways to quality inpatient management of hyperglycemia and diabetes: a call to action.
      ).
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