Long-term improvements in insulin prescribing habits and glycaemic control in medical inpatients associated with the introduction of a standardized educational approach.

BACKGROUND: We carried out an educational strategy to increase physician adherence to 8 recommendations for inpatient evaluation and management of diabetes endorsed by the American Diabetes Association.
METHODS: We evaluated physician attitude, barriers and facilitators to incorporate the proposed recommendations into clinical practice. We analyzed the impact of the educational strategy on process-of-care and outcome variables in 138 patients with type 2 diabetes discharged from the internal medicine department before the intervention, at 3-month and at 9-month after the intervention.
RESULTS: After the educational intervention there was a high motivation of physicians to adhere to the proposed recommendations. The intervention caused a significant reduction of insulin administered by sliding scale (50% vs. 7% vs. 3%, P=0.000), and in the median pre-discharge glycaemic values (185 mg/dL vs. 153 mg/dL vs. 161 mg/dL, P=0.005), in the three periods, respectively. The use basal-bolus-correction insulin dosage increased in postintervention periods (17% vs. 85% vs. 99%, P=0.004). Hypoglycaemia (glycaemia <60 mg/dL) episodes were similar among the three periods (0.30% vs. 0.70% vs. 1.07%, P=0.10). The intervention required improvements to promote haemoglobin(A1c) ordering on admission and diabetes intensification therapy at discharge when needed.
CONCLUSION: Our educational strategy improved physician adoption of practice guidelines.