ABSTRACT Objective: To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management. Methods: As part of a planned educational program, a questionnaire was designed and administered to deter- mine the opinions of residents about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients. Results: Of 70 resident physicians from various ser- vices, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was “very important” in critically ill and perioperative patients but only “somewhat important” in non-critically ill patients. Most residents indicated that they would target a thera- peutic glucose range within the recommended levels in published guidelines. Most residents also said they felt “somewhat comfortable” managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy, whereas most residents (48%) were “not at all comfort- able” with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barri- er to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern. Conclusion: Most residents acknowledged the impor- tance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guide- lines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal manage- ment. Educational programs should emphasize inpatient treatment strategies for glycemic control. (Endocr Pract. 2007;13:117-125) INTRODUCTION Hyperglycemia in hospitalized patients is associated with worse outcomes (such as longer lengths of stay and higher mortality) in comparison with outcomes for patients without elevated blood glucose levels (1,2). Both randomized controlled trials and observational studies, however, have shown that outcomes can be improved with aggressive management of hyperglycemia (1,2). Consequently, glucose targets have been proposed for crit- ically and non-critically ill patients in the hospital (2). In addition, glucose goals specifically for the perioperative period have been suggested (3). A consensus conference recently reaffirmed previous position statements about the adverse effect of high blood glucose levels on the outcomes of hospitalized patients and the need to control hyperglycemia in the inpatient set- ting (4). Moreover, the conference emphasized the need to develop broad-based educational programs to increase awareness about the importance of inpatient glycemic control and to develop a standardized set of tools for use by hospitals to improve such care (4). Nationwide, the number of hospitalizations involving patients with a diagnosis of diabetes mellitus has increased (5,6). In our own institution, we have observed an increase in the number of discharges with a diabetes diagnosis (from 14.9% of total discharges in 2001 to 18.9% in 2005). There are indications at both the national (3) and the state level (7) of efforts to improve care for hospital- ized patients with hyperglycemia, and it is likely that indi- vidual hospitals are also taking steps toward enhancement of such care. Nonetheless, diabetes and glucose control continue to be overlooked frequently in the hospital, appropriate therapeutic responses to hyperglycemia do not occur (8,9), and ongoing concern prevails about the slow MANAGEMENT OF INPATIENT HYPERGLYCEMIA: ASSESSING PERCEPTIONS AND BARRIERS TO CARE AMONG RESIDENT PHYSICIANS Curtiss B. Cook, MD, 1 Dean A. McNaughton, MD, 2 Cathleen M. Braddy, MD, 2 Kimberly A. Jameson, 4 Lori R. Roust, MD, 1 Steven A. Smith, MD, 5 Daniel L. Roberts, MD, 2 Stephen L. Thomas, MD, 3 and Bryan P. Hull, MD 2 Submitted for publication June 8, 2006 Accepted for publication August 22, 2006 From the 1 Division of Endocrinology, 2 Division of Hospital Internal Medicine, 3 Division of Community Internal Medicine, and 4 Section of Planning Services and Practice Analysis, Mayo Clinic Arizona, Scottsdale, Arizona, and 5 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Rochester, Rochester, Minnesota. Address correspondence and reprint requests to Dr. Curtiss B. Cook, Division of Endocrinology, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259. © 2007 AACE. ENDOCRINE PRACTICE Vol 13 No. 2 March/April 2007 117 Original Article