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The Diabetes Educator, Vol. 34, No. 1, 75-83 (2008)
DOI: 10.1177/0145721707311957
© 2008 American Association of Diabetes Educators; Published by SAGE Publications

FEATURES

Beliefs About Hospital Diabetes and Perceived Barriers to Glucose Management Among Inpatient Midlevel Practitioners

Curtiss B. Cook, MD, Kimberly A. Jameson, Zachary C. Hartsell, PA, Mary E. Boyle, CNP, BC-ADM, CDE, Brenda J. Leonhardi, MSN, FNP-C, Marci Farquhar-Snow, MN, ACNP, CCNS and Karen A. Beer, PA, CDE

From the Division of Endocrinology (CBC, MEB, BJL, KAB), the Division of Planning Services (KAJ), the Division of Hospital Internal Medicine (ZCH), and the Division of Cardiovascular Diseases (MF-S), Mayo Clinic, Scottsdale, Arizona.

Correspondence to Curtiss B. Cook, MD, Division of Endocrinology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259 (cook.curtiss{at}mayo.edu).

Purpose

The purpose of this study is to explore attitudes among inpatient midlevel practitioners about hospital hyperglycemia and to identify perceived barriers to care.

Methods

A questionnaire previously applied to resident physicians was administered to midlevel providers (physician assistants and nurse practitioners) to determine their beliefs about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in the hospital. Barriers to care reported in this study were also combined with responses from the prior resident survey.

Results

Most respondents indicated that glucose control was very important in critically ill, noncritically ill, and perioperative patients. However, most felt only somewhat comfortable treating hyperglycemia and hypoglycemia and with using subcutaneous insulin; respondents expressed the least amount of confidence with using insulin infusions and insulin pumps. Respondents were not familiar with existing institutional polices and preprinted order sets relating to glucose management. The most commonly reported barrier to hyperglycemia management in the hospital was lack of familiarity with how to useinsulin, a finding that persisted after analyzing composite resident and midlevel responses.

Conclusions

Most midlevel providers acknowledged the importance of good glucose control in the hospital. Lack of familiarity with how to use insulin in the hospital was the most commonly cited barrier to care. Educational programs should heavily emphasize inpatient treatment strategies.


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