2026 Southeastern Residency Conference

Impact of Pharmacist-Led Blood Glucose Management on Patients in the Medical Intensive Care Unit  
Abigail Reeves, Ann Maxwell, Megan Lail, Marwan Elya 
 
Background
Hyperglycemia affects up to 60% of critically ill patients and is associated with increased morbidity, mortality, and healthcare costs. Beginning in January 2026, “Hospital Harm” Severe Hypoglycemia and Severe Hyperglycemia, two measures established by The Centers for Medicare and Medicaid Services, will become mandatory for annual hospital reporting. Pharmacist-managed insulin protocols have demonstrated improved glucose control and reduced severe hypoglycemia, but data in intensive care units remainslimited. This study aims to evaluate the impact of clinical pharmacist consultation for insulin management versus physician or advanced practice provider management on blood glucose time within goal range in critically ill patients. 
 
Methods
This study was a single center, retrospective, chart review of adult patients admitted to the medical intensive care unit (MICU) between June 1st, 2025, through January 31st, 2026. After the first 24-hours of MICU admission, patients 18 years of age and older were screened for inclusion criteria, including new-onset or past medical history of diabetes, glycated hemoglobin (A1c) > 6.5% within three months or during admission, two blood glucoses >180 mg/dL or receipt of insulin therapy. Based on provider discretion, the consult “Pharmacy to manage insulin” was ordered, and electronic medical record (EMR) documentation was utilized to write a daily progress note. Progress notes included history of diabetes, home diabetes regimen if applicable, last three A1C values, current insulin regimen, other diabetes medications, steroid use, dextrose-containing fluids, diet, and changes indicated. Pharmacists managed insulin only during the patients' MICU stay, with the capability to add or adjust long-acting and short-acting insulin. Pharmacistmanagement of blood glucose was conducted from 8:00 a.m. - 5:00 p.m and if urgent adjustment was needed outside of these hours, the intensivist intervened. The consult was limited to the MICU and was discontinued when each patient was physically transferred from the unit. A guidance document was developed for reference after service hours and during cross coverage. 
 
Results
The post-intervention group (n=124) demonstrated improved glycemic control compared to the pre-intervention group (n=112). The post-intervention group achieved a higher number of blood glucose values within the goal range (68.8% vs. 62.7%, p=<0.001). At the patient level, the post-intervention group had a higher median percentage of blood glucoses within goal range (80% vs. 64.3%, p=0.001). Hypoglycemic events showed no significant differences between groups, with similar proportions of patients experiencing hypoglycemia (22% vs. 19%, p=0.575), and no significant change in the total number of hypoglycemic events (2% vs. 1.23%, p=0.067). However, the post-intervention group had a significantly lower proportion of patients with hyperglycemic events (73% vs. 89%, p=0.001) and fewer total hyperglycemic events (30% vs. 36%, p<0.001). Additionally, the percentage of ICU days with hyperglycemia was significantly reduced in the post-intervention group (46% vs. 60%, p<0.001). These findings suggest that the intervention improved glucose control, particularly by reducing hyperglycemic events, without increasing hypoglycemia.  
 
Conclusions
Pharmacist consultation for insulin management was associated with an increase in the number of blood glucose values within the target range and a reduction in hyperglycemic events. These improvements occurred without a significant change in hypoglycemia, indicating that glycemic control improved without increasing hypoglycemic risk.