FP32-4 High Confidence and Low Knowledge: A Dangerous Intersection

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP32-Health Outcomes & Quality Improvement
Monday, June 17, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 11:00 AM
Room 301 (Moscone Center)

Poster Board MON-285
Jessica Abramowitz*1, Jennifer Schwarz2, Maria Elena Pena3 and Tracy Lynn Breen4
1Hofstra North Shore LIJ school of medicine, New Hyde Park, NY, 2NYU Langone Medical Center, New York, NY, 3North Shore University Hospital/LIJHS, Great Neck, NY, 4North Shore Long Island Jewish H, Pelham, NY
Background:  According to Endocrine Society clinical practice guidelines hospitalized diabetic patients with non-critical illness should be managed with basal-bolus subcutaneous insulin.[1]Studies have shown that physicians often rely solely on correctional insulin for inpatient glucose control.[2]

Methods: A 13 question survey was administered at Hofstra North Shore LIJ, a tertiary care academic medical center, to internal medicine housestaff and attending physicians regarding inpatient diabetes management practices and insulin prescribing. We assessed physicians’ comfort in prescribing insulin, confidence regarding their understanding of insulin use, current practice of inpatient diabetes management and knowledge regarding basic insulin pharmacodynamics. 

Results: 81 physicians completed the survey (11 interns, 27 senior residents, 6 fellows and 37 attending physicians). With respect to inpatient diabetes management, 61% of attendings and 36% of housestaff replied that they continue oral hypoglycemic agents on admission. 83% of attendings reported using some type of insulin therapy as opposed to 90% of residents. Of note, a difference was seen regarding concern for hypoglycemia, with 92% of attendings describing themselves as “somewhat” or “very concerned” vs. 84% of residents being “somewhat concerned” or “neutral”. Housestaff comprised the majority of providers who were both very comfortable prescribing insulin and very confident in their knowledge of insulin. When asked to identify the correct pharmacodynamic profiles of aspart, regular and glargine insulin, most physicians responded incorrectly, regardless of level of training.

Conclusions:  This survey highlights that physicians in our institution still frequently use oral antidiabetic agents in hospitalized patients despite recommendations to suspend them. This study also illustrates differences in prescribing habits between residents and attendings. Attending physicians are more concerned for hypoglycemia while housestaff are very comfortable with prescribing insulin and confident in their knowledge. This is concerning in light of growing data that hypoglycemia may contribute to both short and long term harm. High confidence combined with limited knowledge present unique challenges to improving patient safety in the hospital. The results of this study emphasize the need to further educate physicians (at all levels) on basic principles of insulin therapy and best practices around the inpatient management of patients with diabetes.

[1]J Clin Endocrinol Metab. 2012 Jan;97(1):16-38.Management of hyperglycemia in hospitalized patients in non-critical caresetting: an endocrine society clinical practice guideline[2] Arch Intern Med. 1997 Mar 10;157(5):545-52.Glycemic control and sliding scale insulin use in medical inpatients withdiabetes mellitus.

Nothing to Disclose: JA, JS, MEP, TLB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm