MON-664 Are Hospitals Doing Enough in Caring for Patients with Diabetes?Results of a Landmark Survey: Current State of Inpatient Diabetes Care and Glycemic Management

BACKGROUND On average, 1 of every 3 hospitalized patients — the majority with diabetes — requires insulin to control blood glucose during their stay. Although widely prescribed and absolutely necessary, insulin is inherently dangerous: 50% of all medication errors involve insulin, including 1/3 of all fatal medication errors. Results of a nationwide survey indicate that prioritization of glycemic control is lacking, which hinders high reliability and increases risk of morbidity and mortality. METHODS Healthcare professionals who serve in roles involving diabetes care and glycemic management were invited to participate in an online survey. To qualify, an initial question that read: “Where do you work?” had to be answered “hospital or health system with focus on inpatients” (those who answered “physician’s office or clinic with focus on outpatients” were disqualified). There were a total of 619 respondents from 408 U.S. hospitals. KEY RESULTS • The consensus among respondents is that fear of hypoglycemia has a strong influence on the prescribing of insulin (i.e., causes non-prescribing or lack of intensification following hyperglycemia). On a scale of 1 to 5, with 1 being ‘very little if any influence’ and 5 being ‘considerable influence,’ the average weighted score was 3.45. • About 70% of respondents are of the opinion glycemic control is ‘extremely important’ or ‘very important’ to nurses and physicians, whereas about 48% believe this to be true of senior clinical executives and 25% believe this to be true of non-clinical senior executives. • Only 24% of respondents maintain their hospital uses primarily basal bolus for subcutaneous insulin therapy. Close to 34% maintain their hospital uses primarily sliding scale and 42% maintain their hospital uses sliding scale and basal bolus equally as often. The top three barriers to full adoption of basal bolus insulin are: (1) inadequate prescriber knowledge about basal-bolus-correction regimens, (2) beliefs that sliding scale is acceptable practice and not harmful, and (3) difficulties coordinating glucose monitoring, insulin administration and meal delivery. • Slightly more than 2/3 of respondents work at a hospital that routinely tracks and reports the rate of hypoglycemia (on a monthly or quarterly basis). Of those, 54% use a threshold of 60 and/or 70 mg/dL exclusively, which encompasses all episodes of hypoglycemia without accounting for severity; only 24% use thresholds of 60 and/or 70 mg/dL as well as thresholds of 40, 50 and/or 54 mg/dL, allowing episodes of greater severity to be isolated for analysis and quality improvement. CONCLUSION Results of the survey indicate better care, specifically better glycemic control, is needed for hospitalized patients with diabetes. With the shift from volume to value and a stronger focus on quality and safety, this data should be catalyst for making glycemic control a strategic imperative.