Perceptions of resident physicians about management of inpatient hyperglycemia in an urban hospital

Abstract

BACKGROUND: Information regarding practitioner beliefs about inpatient diabetes care is limited. OBJECTIVE: To assess resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal glycemic control in an urban hospital setting. DESIGN: A previously developed questionnaire was modified and administered. Residents were asked about the importance of inpatient glucose control, desirable glucose ranges, and problems encountered when managing hyperglycemia. SETTING: Urban teaching hospital. RESULTS: Of 85 resident physicians, 66 completed the survey (mean age, 31 years; 47% men; 33% in first residency year). Most respondents categorized glucose control as "very important" in critically-ill and perioperative patients but only "somewhat important" in non-critically-ill patients. Most residents said they would target a therapeutic glucose range within the recommended levels. Most residents (88%) also said they felt "very comfortable" or "somewhat comfortable" using subcutaneous insulin therapy, whereas some were "not at all comfortable" with either subcutaneous (11%) or intravenous (18%) administration. In general, respondents were not very familiar with existing institutional policies and preprinted order sets. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and their use. Anxiety about hypoglycemia was only the third most frequent concern. CONCLUSION: Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.