Improving Diabetes Care in the Hospital Using Guideline-Directed Orders

Improving glycemic control for inpatients with diabetes remains a formidable challenge. While the use of inadequate and nonphysiological insulin regimens is widespread, there are many potential barriers to improving physician and nursing hospital practices in this area. This article describes an integrated program that utilizes subcutaneous and intravenous insulin order forms incorporating guidelines that encourage more appropriate insulin therapy in the hospital. This approach has resulted in a significant decrease in one factor associated with suboptimal insulin use for inpatients: reliance on sliding-scale short-acting insulin alone for blood glucose control.