Achieving Tight Glycemic Control With New Technology

Abstract

Cardiac surgery remains one of the most commonly performed surgeries in the world. Intensive insulin therapy has shown to reduce infection in patients undergoing open-heart surgery and is considered standard of care. New technologies are available to achieve and maintain recommended blood glucose goals. These include computer-driven intensive insulin protocols (vs paper-based algorithms) and continuous blood glucose monitors. Managing tight glucose control in cardiac surgery patients has been shown to decrease costs in terms of measurable outcomes including infection, mortality, and length of stay. The advanced practice nurse is uniquely qualified to implement new technologies and can be instrumental in increasing compliance with clinical practice guidelines while decreasing hospital costs.

A nurse‐guided, basal‐prandial insulin treatment protocol for achieving glycaemic control of hospitalized, non‐critically ill diabetes patients, is non‐inferior to physician‐guided therapy: A pivotal, nurse‐empowerment study

“…Autonomous implementation of treatment algorithms for glycaemic control of patients by nurses is well established in the setting of acute care facilities such as intensive care unit and intensive cardiac care unit; yet we could not find evidence to support such autonomy among the nursing staff of internal medicine wards. On the contrary, lack of trained staff members in diabetes control and usage of a sliding scale without incorporating basal insulin into the therapeutic algorithm were identified as barriers to adequate glycaemic control …”