Current Standards of Care For Inpatient Glycemic Management And Metabolic Control: Is It Time For Definite Standards And Targets?

Garber, Alan J.; Seidel, Joan; Armbruster, Mary

doi:10.4158/ep.10.s2.10

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…Just as clinical trials in the outpatient setting have demonstrated the benefits of good glycemic control,28–30 recent studies have also suggested that treatment of hyperglycemia during hospitalization can improve outcomes 10, 11. Consequently, there has been increased attention to the management of glucose in the hospital, with recognition of the need for inpatient‐specific standards for diabetes care 10, 11, 31. Optimization of management and of education about diabetes and hyperglycemia in the hospital requires better understanding of current care practices in order to determine where to direct interventions.…”

Section: Discussionmentioning

confidence: 99%

Diabetes care in the hospital: Is there clinical inertia?

Knecht

Gauthier

Castro

et al. 2006

Journal of Hospital Medicine

104

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BACKGROUND Effective control of hospital glucose improves outcomes, but little is known about hospital management of diabetes. OBJECTIVE Assess hospital‐based diabetes care delivery. DESIGN Retrospective chart review. SETTING Academic teaching hospital. PATIENTS Inpatients with a discharge diagnosis of diabetes or hyperglycemia were selected from electronic records. A random sample (5%, n = 90) was selected for chart review. MEASUREMENTS We determined the percentage of patients with diabetes or hyperglycemia documented in admission, daily progress, and discharge notes. We determined the proportion of cases with glucose levels documented in daily progress notes and with changes in hyperglycemia therapy recorded. The frequency of hypoglycemic and hyperglycemic events was also determined. RESULTS A diabetes diagnosis was recorded at admission in 96% of patients with preexisting disease, but daily progress notes mentioned diabetes in only 62% of cases and 60% of discharge notes; just 20% of discharges indicated a plan for diabetes follow‐up. Most patients (86%) had bedside glucose measurements ordered, but progress notes tracked values for only 53%, and only 52% had a documented assessment of glucose severity. Hypoglycemic events were rare (11% of patients had at least one bedside glucose < 70 mg/dL), but hyperglycemia was common (71% of cases had at least one bedside glucose > 200 mg/dL). Despite the frequency of hyperglycemia, only 34% of patients had their therapy changed. CONCLUSIONS Practitioners were often aware of diabetes at admission, but the problem was often overlooked during hospitalization. The low rate of documentation and therapeutic change suggests the need for interventions to improve provider awareness and enhance inpatient diabetes care. Journal of Hospital Medicine 2006;3:151–160. © 2006 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Diabetes care in the hospital: Is there clinical inertia?

Knecht

Gauthier

Castro

et al. 2006

Journal of Hospital Medicine

104

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“…The dose of insulin varied from 1 to 12 Units/h according to the patient's starting blood glucose. Once infusion began, blood glucose was checked every hour (using AccuCheck® machines) and the insulin infusion rate changed according to a defined algorithm adopted by the American College of Endocrinology [17]. …”

Section: Methodsmentioning

confidence: 99%

Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients

Al-Niaimi¹,

Ahmed²,

Burish³

et al. 2015

Gynecologic Oncology

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Objective SSI rates after gynecologic oncology surgery vary from 5% to 35%, but are up to 45% in patients with diabetes mellitus (DM). Strict postoperative glucose control by insulin infusion has been shown to lower morbidity, but not specifically SSI rates. Our project studied continuous postoperative insulin infusion for 24 h for gynecologic oncology patients with DM and hyperglycemia with a target blood glucose of <139 mL/dL and a primary outcome of the protocol's impact on SSI rates. Methods We compared SSI rates retrospectively among three groups. Group 1 was composed of patients with DM whose blood glucose was controlled with intermittent subcutaneous insulin injections. Group 2 was composed of patients with DM and postoperative hyperglycemia whose blood glucose was controlled by insulin infusion. Group 3 was composed of patients with neither DM nor hyperglycemia. We controlled for all relevant factors associated with SSI. Results We studied a total of 372 patients. Patients in Group 2 had an SSI rate of 26/135 (19%), similar to patients in Group 3 whose rate was 19/89 (21%). Both were significantly lower than the SSI rate (43/148, 29%) of patients in Group 1. This reduction of 35% is significant (p = 0.02). Multivariate analysis showed an odd ratio = 0.5 (0.28–0.91) in reducing SSI rates after instituting this protocol. Conclusions Initiating intensive glycemic control for 24 h after gynecologic oncology surgery in patients with DM and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics.

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“…1 As hospital glycemic control is now an important qualityof-care measure, standardized methods for quantifying the proportion of blood glucose (BG) within target ranges and the incidence of hypo-and hyperglycemia (glucometrics) are needed. 2,3 Even though episodes of hypoglycemia and severe hyperglycemia usually prompt repeat BG measurements, previous reports of glucometrics include these BG measurements in analyses. [4][5][6][7][8][9][10] Thus, the multiple frequent glucose measurements generally required for a single episode of hypoglycemia (to verify the low glucose and monitor until the hypoglycemia has resolved) may lead to a falsely increased reported rate of hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%