PSUN221 Implementation of Scheduled Mealtimes for Improved Glycemic Control among Hospitalized Patients with Diabetic Meal Plans

Abstract

Abstract Objective To improve inpatient glycemic control through implementation of scheduled diabetic mealtimes in coordination with standardized bedside glucose checks and insulin administration times Methods We performed a plan-do-study-act (PDSA) trial in which we modified our standard diabetic diet from on-demand service to scheduled mealtimes with a goal to complete bedside glucose monitoring, meal delivery, and insulin administration all within a one-hour window for each meal. Both patients and clinical staff were actively educated regarding the rationale for this approach; prominent visual cues were implemented, and the menu was modified to include patient-centered information regarding mealtime practices. Low-carbohydrate snacks were offered between meals. Electronic medical record integration included defaulting to scheduled insulin dosing rather than as-needed dosing. Results Early PDSA analysis demonstrated a 98% rate of pre-prandial glucose measurement with a 96% rate of correctional insulin doses ordered, while 91% of overall mealtimes successfully coordinated tray delivery, glucose testing, and insulin administration within one hour. Analysis of glycemic data from before and after our intervention demonstrated decreased overall mean daily glucose (167 to 164mg/dL, p = 0.001), fewer patients with any daily glucose greater than 250mg/dL (from 51% to 47%, p=0.001), and more for whom all glucose readings were between 70 and 249mg/dL (from 43% to 47%, p=0.001). Average pre-prandial blood sugars significantly improved before breakfast (156 to 152mg/dL, p=0.003) and dinner (173 to 165mg/dL, p< 0.001), while no effect was noted with pre-prandial lunchtime measurements. Evening blood sugars declined from 186 to 180mg/dL (p< 0.001). Subgroup analyses demonstrated that patients who presented with baseline poor glycemic control (admission blood sugar >250mg/dL) improved the percentage of patients with all glucose readings between 70 and 249mg/dL (from 12% to 19%, p=0.001), as well as the number of patients with any subsequent glucose >250mg/dL (from 85% to 77%, p=0.003). Patients who presented with better initial blood glucose control still improved their mean daily glucose (161 to 158mg/dL, p=0.005). The percentage of patients who had any glucose less than 70mg/dL did not significantly change throughout the intervention overall or with any subgroup analysis. Discussion/Conclusion The implementation of scheduled mealtimes within a diabetic meal plan contributes to improved glycemic control when compared with on-demand meal availability by streamlining the coordination of blood glucose measurement, meal delivery, and insulin administration. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.