Effectiveness of a Nurse-Managed Protocol to Prevent Hypoglycemia in Hospitalized Patients with Diabetes
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Abstract
Hypoglycemia resulting from insufficient carbohydrate intake is a common challenge in the management of diabetic in-patients treated with insulin.
Objective: This study aimed to evaluate the efficacy of a nurse-managed protocol in preventing hypoglycemia during subcutaneous insulin therapy.
Design: A prospective pre-post-intervention study design was employed.
Methods: The study involved 350 consecutive diabetic in-patients. The incidence of hypoglycemia (defined as blood glucose < 70 mg/dL) during subcutaneous insulin therapy was assessed before (phase A) and after (phase B) implementing the protocol. The protocol included options for patients to choose substitutive food to supplement incomplete carbohydrate intake, adjustment of prandial insulin based on actual carbohydrate consumption in cases of poor appetite or partial food intake, and intravenous glucose infusion during extended fasting periods.
Results: Eighty-four patients were included in phase A, while 266 patients were included in phase B. The median duration of subcutaneous insulin treatment was 7 days (Q1–Q3 6–12) in phase A and 6 days (Q1–Q3 4–9) in phase B. The frequency of hypoglycemic events decreased significantly from 0.34 ± 0.33 per day in phase A to 0.19 ± 0.30 per day in phase B (P > 0.001).
Conclusions: Implementation of a nurse-managed protocol emphasizing carbohydrate intake resulted in a notable reduction in hypoglycemia incidence among diabetic in-patients receiving subcutaneous insulin therapy in the hospital setting.
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