Pilot Study of Clinician-supported Patient Self-management of Hospital Insulin Therapy
Pilot Study of Clinician-supported Patient Self-management of Hospital Insulin Therapy
This study will examine the feasibility of implementing a clinician-supported patient
 self-managed inpatient insulin intervention. It will: assess the number of eligible patients
 presenting over time; assess patients' willingness to enroll; assess patients' ability to
 successfully complete the intervention; examine occurrences of hyperglycemia and
 hypoglycemia; and assess patients' satisfaction with inpatient diabetes care.
Inclusion Criteria:

 -  Admitted to the Hospital of the University of Pennsylvania (HUP) in the past 72 hours.

 -  Current HUP locations are Founders 12, Founders 14, Silverstein 11, and Rhoads 1.

 -  Age 18 years or older.

 -  Type-1 or type-2 diabetes mellitus requiring home basal-bolus insulin therapy
 administered via subcutaneous injection (not pump).

 -  Patient manages own basal-bolus insulin therapy at home without assistance, including
 measuring own blood glucose (at least at mealtimes) and administering own subcutaneous
 insulin.

 -  Patient is willing to use the following insulin products: rapid-acting insulin aspart
 via insulin pen (NovoLog) and long-acting insulin glargine via vial and syringe
 (Lantus).

 -  Most recent hemoglobin A1c was measured within past 6 months and was <7.5%.

 -  Active order for in-hospital basal-bolus or sliding-scale insulin.

 -  Patient is willing and able to record their self-measured blood glucose results, doses
 of insulin that they self-administer, a food journal, and exercise log.

 -  Clinical care team agrees with study inclusion.

 Exclusion Criteria:

 -  Inpatient order for insulin via subcutaneous infusion (i.e., pump) or intravenous
 infusion (i.e., drip).

 -  Inability to perform the activities required by the trial.

 -  Primary reason for admission was hyperglycemia, hypoglycemia, diabetic ketoacidosis,
 hyperglycemic hyperosmolar nonketotic coma, a psychiatric condition, acute alcohol
 poisoning, or acute drug ingestion.

 -  Order for a newly-prescribed or increased dose of a previously-prescribed
 corticosteroid.

 -  Enteral or parenteral nutrition.

 -  Expected length of stay <48h, as determined by treating physician.

 -  At risk for self-harm, as determined by 1-to-1 status placement.

 -  Pregnant, as recorded on medical record.

 -  Cannot understand, speak, and read English.

 -  Patient does not wish to utilize Novolog and Lantus while in the hospital.

 -  Prior enrollment in this trial.

 -  Do not resuscitate status.

 -  Inability to give written informed consent.

 -  Clinical care team disagrees with study inclusion.

 -  Patient has limited mobility such that they cannot safely access the bedside
 medication lockbox.