Digital interventions to improve safety and quality of inpatient diabetes management: A systematic review

Sly, Benjamin; Russell, Anthony; Sullivan, Clair

doi:10.1016/j.ijmedinf.2021.104596

Cited by 18 publications

(7 citation statements)

References 81 publications

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“…Our review found that CDSSs significantly improve blood glucose, blood pressure, and lipid profile (71%, 67%, and 38% of the studies, respectively) and that the risk of hypoglycemia does not increase correspondingly. This aligns with the results of previous reviews [15,16,18,[113][114][115]. In recent years, there has been an increasing focus on long-term outcomes in diabetes care [116][117][118][119][120][121][122].…”

Section: Cdsss Could Be Effective and Safe In Improving Diabetes Caresupporting

confidence: 88%

“…Most CDSSs facilitated users by providing proactive order suggestions and order sets (65/83, 78%) and supporting guidelines, complex protocols, algorithms, and clinical pathways (25/83, 30%). (78) Proactive order suggestions and order sets [31, 33, 35, 38, 40, 43-46, 50, 51, 53, 54, 61, 66, 72, 74, 76, 78, 81, 83, 87, 88, 96, 109] 25 (30) Support for guidelines, complex protocols, algorithms, clinical pathways [31,33,38,45,49,54,61,62,70,78,81,84,93,96,108] 15 (18) Reactive alerts [33,35,42,51,54,59,61,63,81,83,91,93,101,111] 14 (17) Reference information and guidance [55,100] 2 (2) Function: unspecified studies a CDSS: clinical decision support system.…”

Section: Characteristics and Clinical Applications Of Cdsss In Diabet...mentioning

confidence: 99%

“…Some reviews in which only randomized controlled trials (RCTs) were included addressed precise questions, such as the effectiveness of CDSSs in diabetes care [15,16]. Some reviews focused on the use of CDSSs in specific patients or settings, such as inpatients with diabetes in the noncritical care setting [17,18], patients with type 1 diabetes [19][20][21], and patients with type 2 diabetes in primary care [22]. However, a comprehensive analysis of the application of CDSSs in diabetes care is still lacking.…”

Section: Introductionmentioning

confidence: 99%

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Applications of Clinical Decision Support Systems in Diabetes Care: Scoping Review

Huang,

Liang,

et al. 2023

J Med Internet Res

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Background Providing comprehensive and individualized diabetes care remains a significant challenge in the face of the increasing complexity of diabetes management and a lack of specialized endocrinologists to support diabetes care. Clinical decision support systems (CDSSs) are progressively being used to improve diabetes care, while many health care providers lack awareness and knowledge about CDSSs in diabetes care. A comprehensive analysis of the applications of CDSSs in diabetes care is still lacking. Objective This review aimed to summarize the research landscape, clinical applications, and impact on both patients and physicians of CDSSs in diabetes care. Methods We conducted a scoping review following the Arksey and O’Malley framework. A search was conducted in 7 electronic databases to identify the clinical applications of CDSSs in diabetes care up to June 30, 2022. Additional searches were conducted for conference abstracts from the period of 2021-2022. Two researchers independently performed the screening and data charting processes. Results Of 11,569 retrieved studies, 85 (0.7%) were included for analysis. Research interest is growing in this field, with 45 (53%) of the 85 studies published in the past 5 years. Among the 58 (68%) out of 85 studies disclosing the underlying decision-making mechanism, most CDSSs (44/58, 76%) were knowledge based, while the number of non-knowledge-based systems has been increasing in recent years. Among the 81 (95%) out of 85 studies disclosing application scenarios, the majority of CDSSs were used for treatment recommendation (63/81, 78%). Among the 39 (46%) out of 85 studies disclosing physician user types, primary care physicians (20/39, 51%) were the most common, followed by endocrinologists (15/39, 39%) and nonendocrinology specialists (8/39, 21%). CDSSs significantly improved patients’ blood glucose, blood pressure, and lipid profiles in 71% (45/63), 67% (12/18), and 38% (8/21) of the studies, respectively, with no increase in the risk of hypoglycemia. Conclusions CDSSs are both effective and safe in improving diabetes care, implying that they could be a potentially reliable assistant in diabetes care, especially for physicians with limited experience and patients with limited access to medical resources. International Registered Report Identifier (IRRID) RR2-10.37766/inplasy2022.9.0061

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Section: Cdsss Could Be Effective and Safe In Improving Diabetes Caresupporting

confidence: 88%

Section: Characteristics and Clinical Applications Of Cdsss In Diabet...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Applications of Clinical Decision Support Systems in Diabetes Care: Scoping Review

Huang,

Liang,

et al. 2023

J Med Internet Res

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“…Despite these guidelines, sliding‐scale monotherapy persists as a common treatment 6 . Interventions encouraging the use of oral diabetes medications in hospitalized patients are sparse, although previous work in inpatient glycemic control utilizing electronic health record (EHR) order sets has proven successful 7 . Additionally, there have been few studies examining diabetes education for residents, despite numerous studies demonstrating their lack of confidence regarding this topic 8 .…”

Section: Problemmentioning

confidence: 99%

Don't hold the metformin: Enhancing inpatient diabetes education to encourage best practices in a public hospital

Sanders,

Shen,

Alaiev

et al. 2024

Journal of Hospital Medicine

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Inpatient hyperglycemia is associated with increased morbidity, mortality, and length of stay. 1 Clinicians commonly manage hyperglycemia in the hospital with insulin. Basal-bolus insulin regimens provide improved glycemic control in comparison to sliding-scale insulin (SSI) monotherapy. 2,3 In addition, clinicians commonly discontinue oral diabetes medications on admission, although recent studies suggest metformin and dipeptidyl peptidase 4 (DPP-4) inhibitors are safe to use in the hospital. 2 The low risk of hypoglycemia and favorable tolerability profile of these medications make them attractive options. Society guidelines from the American Diabetes Association and the American Academy of Family Physicians recommend physicians consider these medications for appropriate inpatients. 4,5 Despite these guidelines, sliding-scale monotherapy persists as a common treatment. 6 Interventions encouraging the use of oral diabetes medications in hospitalized patients are sparse, although previous work in inpatient glycemic control utilizing electronic health record (EHR) order sets has proven successful. 7 Additionally, there have been few studies examining diabetes education for residents, despite numerous studies demonstrating their lack of confidence regarding this topic. 8 Here we describe an initiative to improve inpatient diabetes education.

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“…The National Academy of Medicine recommends CPOE to prevent medicationrelated errors and increase medication administration efficiency (15). Systematic reviews of randomized controlled trials using computerized advice to improve glycemic outcomes in the hospital found significant improvement in the percentage of time individuals spent in the target glucose range, lower mean blood glucose levels, and no increase in hypoglycemia (16,17). Where feasible, there should be structured order sets that provide computerized guidance for glycemic management.…”

mentioning

confidence: 99%

16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023

ElSayed¹,

Aleppo²,

Aroda³

et al. 2022

Diabetes Care

147

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The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Digital interventions to improve safety and quality of inpatient diabetes management: A systematic review

Cited by 18 publications

References 81 publications

Applications of Clinical Decision Support Systems in Diabetes Care: Scoping Review

Applications of Clinical Decision Support Systems in Diabetes Care: Scoping Review

Don't hold the metformin: Enhancing inpatient diabetes education to encourage best practices in a public hospital

16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023

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