Original ArticleContinuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy can be Safely Used in the Hospital in Select Patients
Section snippets
INTRODUCTION
Outpatient continuous subcutaneous insulin infusion (CSII), commonly referred to as insulin pump therapy, delivers intensive insulin treatment for optimal glucose control. As the use of CSII increases, health care providers in the hospital may more frequently face the issue of how best to manage the care of patients who are using CSII. Many individuals on CSII therapy are educated extensively in the self-management of diabetes mellitus and can invest considerable time and money in the
Description of Facility
Our tertiary care academic medical center is a 200-plus–bed facility in metropolitan Phoenix, Arizona. All general medical and surgical specialties for adult patients are represented; pediatric care and obstetric care are not provided. The hospital also has a level II trauma center and an inpatient rehabilitation unit. Inpatient care is provided by various types of practitioners, including resident physicians, students in allied health and medical school, physician assistants, nurse
Patient Characteristics
We identified a total of 50 hospital admissions that occurred between November 1, 2005, and February 8, 2008, for 35 individual patients who had been receiving outpatient insulin pump therapy. Eight unique patients had a total of 23 admissions. Twenty-one patients were receiving their outpatient diabetes care outside of our health system. The mean age of the 35 patients was 55 years; the mean diabetes duration was 32 years. The mean selfreported duration of CSII therapy was 4 years. All
DISCUSSION
Patients who receive CSII therapy are educated intensively on diabetes self-management and invest considerable time in mastering the technology. We have often encountered situations in which patients on outpatient CSII therapy are eager to continue this treatment while hospitalized. However, there are many different insulin pump models available, and given the infrequency of seeing patients who use an insulin pump, practitioners in hospitals cannot be expected to gain expertise with the
CONCLUSION
We conclude that CSII therapy can be safely continued in a hospital setting in select patients. Overall implementation of our inpatient insulin pump policy has been successful. The necessary documentation and procedures are being accomplished for most patients, although improvement is needed to reach 100% compliance in performance of all components. Our analysis also provided us with ongoing data about the characteristics of the inpatient population that receives CSII. Determining whether CSII
DISCLOSURE
The authors have no conflicts of interest to disclose.
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