Frequently Repeated Glucose Measurements Overestimate the Incidence of Inpatient Hypoglycemia and Severe Hyperglycemia

Weinberg, Melissa E.; Bacchetti, Peter; Rushakoff, Robert J

doi:10.1177/193229681000400311

Cited by 23 publications

(22 citation statements)

References 14 publications

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“…We analysed point‐of‐care BG measurements for each patient from ward admission until discharge. We excluded BG measurements after admission day 14 (to avoid skewing by data from the few patients with prolonged hospital stays), BG measurements during intensive care admissions or intravenous insulin infusions, and closely repeated measurements following episodes of hypoglycaemia or hyperglycaemia, as previously described …”

Section: Methodsmentioning

confidence: 99%

Glucometric benchmarking in an Australian hospital enabled by networked glucose meter technology

Kyi

Colman

Rowan

et al. 2019

Medical Journal of Australia

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Objective: To assess glucometric outcomes and to estimate the incidence of hypo-and hyperglycaemia among non-critical care inpatients in a major Australian hospital.Design, setting and participants: A prospective 10-week observational study (7 March -22 May 2016) of consecutive inpatients with diabetes or newly detected hyperglycaemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Point-of-care blood glucose (BG) data were collected with networked glucose meters. Main outcome measures:Glycaemic control, as assessed with three glucometric models (by population, by patient, by patientday); incidence of adverse glycaemic days (AGDs; patient-days with BG levels below 4 mmol/L or above 15 mmol/L). Results:During the study period, there were 465 consecutive admissions of 441 patients with diabetes or newly detected hyperglycaemia, and 9817 BG measurements over 2953 patientdays. The mean patient-day BG level was 9.5 mmol/L (SD, 3.3 mmol/L). The incidence of hyperglycaemia was higher than for a United States hospital benchmark (patient-days with mean BG level above 10 mmol/L, 37% v 32), and that of hypoglycaemia lower (proportion of patient-days with mean BG level below 3.9 mmol/L, 4.1% v 6.1%). There were 260 (95% CI, 245-277) AGDs per 1000 patient-days; the incidence was higher in medical than surgical ward patients (290 [CI,] v 206 [CI, 181-230] per 1000 patient-days). 604 AGDs (79%) were linked with 116 patients (25%). Episodes of hyperglycaemia (BG above 15 mmol/L) were more frequent before lunch, dinner, and bedtime; 94 of 187 episodes of hypoglycaemia (BG below 4 mmol/L) occurred between 11 pm and 8 am.Discussion: Glucometric analysis supported by networked glucose meter technology provides detailed inpatient data that could enable local benchmarking for promoting safe diabetes care in Australian hospitals.The known: Despite the importance of glucose control for people admitted to hospital, inpatient glucose levels have not been systematically audited or benchmarked in Australia. The new:We report the first detailed glucometric analysis for inpatients in a major Australian hospital, an analysis facilitated by networked glucose meter technology. For 260 of every 1000 patient-days, blood glucose levels were outside the safe range for hospital patients. The incidence of hyperglycaemia was higher and that of hypoglycaemia lower than in an American hospital benchmark.

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Section: Methodsmentioning

confidence: 99%

Glucometric benchmarking in an Australian hospital enabled by networked glucose meter technology

Kyi

Colman

Rowan

et al. 2019

Medical Journal of Australia

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“…Long patient stays are often related to disposition issues rather than clinical care; therefore, only inpatients on the medical teaching service with at least four BG measurements and a length of stay <45 days were included in the analysis. Frequently repeated BG values in dysglycemic patients may skew the data due to oversampling 22,23 . The earliest BG value of any 3‐h time‐frame was therefore deemed representative of an “event blood glucose” (eBG) and selected for analysis.…”

Section: Methodsmentioning

confidence: 99%

Durability of the effect of online diabetes training for medical residents on knowledge, confidence, and inpatient glycemia

Tamler

Green

Skamagas

et al. 2012

Journal of Diabetes

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“…It is clearly evident that more frequent glucose measurements lead to increased detection of hypoglycemia. However, overestimation might happen as well in this scenario [35]. In addition to this issue, the single-center study design precludes these findings from being generalized to the entire population of non-critically ill patients hospitalized in internal medicine units.…”

Section: Discussionmentioning

confidence: 96%

Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study

et al. 2020

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AbstractThe objective of the work was to study admission parameters associated with an increased incidence of hypoglycemia during hospitalization of non-critically ill patients. Included in this cross-sectional study were patients admitted to internal medicine units. The Nutritional Risk Screening 2002 (NRS2002) was used for nutritional screening. Data recorded included admission serum albumin (ASA) and all glucose measurements obtained by the institutional blood glucose monitoring system. Neither of these are included in the NRS2002 metrics. Hypoalbuminemia was defined as ASA<3.5 g/dl. Patients were categorized as hypoglycemic if they had at least one documented glucose≤70 mg/dl during the hospitalization period. Included were 1342 patients [median age 75 years (IQR 61–84), 51.3% male, 52.5% with diabetes mellitus, (DM)], who were screened during three distinct periods of time from 2011–2018. The incidence of hypoglycemia was 10.8% with higher rates among DM patients (14.6 vs. 6.6%, p<0.001). Hypoglycemia incidence was negatively associated with ASA regardless of DM status. Multivariable regression showed that ASA (OR 0.550 per g/dl, 95% CI 0.387–0.781, p=0.001) and positive NRS2002 (OR 1.625, 95% CI 1.072–2.465, p=0.022) were significantly associated with hypoglycemia. The addition of hypoalbuminemia status to the NRS2002 tool improved the overall sensitivity from 0.55 to 0.71, but reduced specificity from 0.63 to 0.46. The negative predictive value was 0.93. Our data suggest that the combination of positive malnutrition screen and hypoalbuminemia upon admission are independently associated with the incidence of hypoglycemia among non-critically ill patients, regardless of diabetes mellitus status.

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Frequently Repeated Glucose Measurements Overestimate the Incidence of Inpatient Hypoglycemia and Severe Hyperglycemia

Abstract: Glucometric reports should exclude repeated BG measurements from a single clinical episode of hypo- or hyperglycemia in order to accurately reflect inpatient glycemic control.

Cited by 23 publications

References 14 publications

Glucometric benchmarking in an Australian hospital enabled by networked glucose meter technology

Glucometric benchmarking in an Australian hospital enabled by networked glucose meter technology

Durability of the effect of online diabetes training for medical residents on knowledge, confidence, and inpatient glycemia

Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study

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