Transmucosal glucose and evidence based medicine

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Just a quick poll here, how many people's services have protocols, standing orders, or unwritten general operating procedures that involve placing oral glucose between the cheek and gums of a hypoglycemic patient that is not able to follow commands? I'm asking for a very specific reason.

You see, when I first started out, there was this debate of whether to use the oral glucose in that fashion or not. One camp said yes, that the amount of glucose absorbed was enough to raise the BGL in a hypoglycemic patient. The other camp, of which I belonged to said no, that's not a good idea, introducing a foreign, sticky substance into the orophaynyx of an unconscious person was just asking for airway trouble. Debates were entertained. Arguments were had. Wars were waged.

Through the years I have come across services that recommend this procedure for administration of oral glucose, and others that specifically forbid it. So I decided one day to see if anyone had ever done a study about its effectiveness.

Lo and behold, the good people at the Journal of the American Medical Association did a study, and found that the amount of glucose absorption through the buccal membranes was less than 0.05 mg. In other words, it doesn't work. The title of the article, "Bioactivity of Instant Glucose, Failure of Absorption Through Oral Mucosa", was a big tip off. (Here's the link in case you don't believe me. http://www.ncbi.nlm.nih.gov/pubmed/691147 )

But here's the kicker: This study was done in 1978! Why in then name of all that is holy would anybody be arguing about this 30 some odd years later? How does that work? Really smart people did a lot of work and provided some conclusive evidence, some of the most conclusive evidence I've seen about a debated procedure. What hope is there for us to move into evidence based medicine when even when a conclusive study is done, the results are ignored? I don't get it.