Insulin-Related Knowledge Among Health Care Professionals at a Tertiary Hospital

Abstract

In recent decades, the prevalence of diabetes has been increasing in many countries, including Singapore.1–3 Consequently, a large number of hospital admissions are related either directly or indirectly to diabetes or to one of its many complications. Approximately 30% of admissions to our tertiary hospital are diabetes related (based on internal audit data). Insulin therapy is required for the management of hyperglycemia in patients with or without diabetes. The main danger with insulin use is life-threatening hypoglycemia. Insulin is one of the five “high-alert” medications identified by the Joint Commission on Accreditation of Healthcare Organizations to have a significant risk of injurious consequences in the event of a medication error.4 Insulin therapy has grown more complex with the advent of insulin analogs and new insulin regimens, and the presence of knowledge gaps among health care professionals (HCPs) has been one of the important factors resulting in errors in insulin use.5 This is compounded by similar-sounding trade or generic insulin names (e.g., “lente” [an intermediate-acting human insulin formulation] and “Lantus” [the trade name for the long-acting insulin analog glargine])6 and by systems in which different HCPs are responsible for prescribing and administering insulin.7 Physicians, nurses, and pharmacists all play important roles in inpatient insulin use. Studies in Europe, America, and South Asia have shown significant deficits in insulin-related knowledge among health care workers.8–10 Nurses have been found to have inadequate knowledge to teach patients basic insulin administration skills,8,9 and physicians have been found to give suboptimal diabetes care (based on American Diabetes Association [ADA] guidelines).10 However, to our knowledge, there are no published studies on insulin-related knowledge from Singapore. In this study, we used an anonymous survey to assess insulin-related knowledge among HCPs at a tertiary hospital …