Improving Intravenous and Subcutaneous Insulin Overlap During Treatment of Diabetic Ketoacidosis: A Quality Improvement Project

Andrew A. Welch, DO; David Toro-Tobon, MD; Kharisa N. Rachmasari, MD; Rashi B. Sandooja, MBBS; Leili Rahimi, MD; Sneha Mohan, MBBS; Jennifer R. Hewlett, MD; Jennifer Clark, MD; Arvind Maheshwari, MD; Catherine Zhang, MD; Juan P. Brito, MD

Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Jun 2024)

Improving Intravenous and Subcutaneous Insulin Overlap During Treatment of Diabetic Ketoacidosis: A Quality Improvement Project

Andrew A. Welch, DO,
David Toro-Tobon, MD,
Kharisa N. Rachmasari, MD,
Rashi B. Sandooja, MBBS,
Leili Rahimi, MD,
Sneha Mohan, MBBS,
Jennifer R. Hewlett, MD,
Jennifer Clark, MD,
Arvind Maheshwari, MD,
Catherine Zhang, MD,
Juan P. Brito, MD

Affiliations

Andrew A. Welch, DO: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes & Metabolism, University of Cincinnati, Cincinnati, OH; Correspondence: Address to Andrew A. Welch, DO, IM Division of Endocrinology University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267.
David Toro-Tobon, MD: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
Kharisa N. Rachmasari, MD: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
Rashi B. Sandooja, MBBS: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
Leili Rahimi, MD: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
Sneha Mohan, MBBS: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
Jennifer R. Hewlett, MD: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
Jennifer Clark, MD: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN; Department of Endocrinology, Diabetes, and Nutrition, PeaceHealth Medical Group, Bellingham, WA
Arvind Maheshwari, MD: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN; Department of Endocrinology, Diabetes and Metabolism, Advocate Health Care, South Elgin, IL
Catherine Zhang, MD: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN; Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI
Juan P. Brito, MD: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN

Journal volume & issue: Vol. 8, no. 3
pp. 293 – 300

Abstract

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Objective: To reduce the frequency of insufficient overlap of intravenous (IV) and subcutaneous (SC) insulin during the treatment of diabetic ketoacidosis (DKA) as a quality improvement project. Patients and Methods: Rates of insufficient IV and SC insulin overlap (250 mg/dL), rebound DKA, length of hospital stay, and duration of IV insulin therapy were similar before and after intervention. Conclusion: Using quality improvement methodology, the rates of insufficient IV to SC insulin overlap during treatment of DKA in a large tertiary care referral center were measured and reduced through an electronic medical record–based best practice advisory targeting hospital providers.

Published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes

ISSN: 2542-4548 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General)
Website: https://www.journals.elsevier.com/mayo-clinic-proceedings-innovations-quality-and-outcomes/

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