SAT-615 - High Prevalence of Hyperglycemia and Variable Insulin Use in Hospitalized Patients with Diabetes: A Quality Improvement Analysis

Background:
Inpatient hyperglycemia is associated with increased morbidity and mortality. Despite guideline recommendations favoring basal-based insulin regimens, sliding scale insulin (SSI) alone remains commonly used. Characterizing local practice patterns is essential to identify targets for quality improvement.

Objective:
To evaluate glycemic control and insulin management patterns among hospitalized patients with diabetes in a community hospital.

Methods:
We conducted a retrospective observational study as part of a quality improvement initiative. Consecutive adult patients with diabetes admitted over a defined period were included. For patients with multiple hospitalizations, only the first admission was analyzed. Data collected included all recorded blood glucose values, insulin regimens (SSI alone or SSI with basal insulin), and therapy adjustments during hospitalization. Glycemic control was assessed using mean glucose, proportion of values within predefined ranges, and glycemic variability measured by coefficient of variation

Results:
A total of 50 patients with 1,716 glucose readings were analyzed. Mean glucose was 204.6 mg/dL. Overall, 38.5% of glucose values were within target range (100–180 mg/dL), while 51.45% were above 180 mg/dL, and only 1.8% were below 70 mg/dL. The mean coefficient of variation was 32.6%, indicating moderate glycemic variability. 28% of patients were managed with SSI alone and 22% with SSI plus basal insulin. Insulin regimens were modified during hospitalization in 36% of patients.

Conclusions:
This analysis demonstrates a high burden of inpatient hyperglycemia, with over half of glucose values exceeding recommended targets. Persistent reliance on SSI-based regimens and frequent need for therapy adjustments highlight gaps between guideline recommendations and clinical practice. These findings identify clear opportunities for system-level interventions to promote basal-based insulin strategies and improve inpatient glycemic outcomes.

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