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

Abstract

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.

Management of diabetes and hyperglycaemia in the hospital

“…A substantial advancement in documentation has been the use of networked glucose meters to incorporate results in the electronic health record. 113 Work has been done to incorporate continuous glucose monitoring in the hospital setting. The FDA has approved two continuous glucose monitoring systems (GlucoScout and OptiScanner 5000) that extract venous blood frequently and intermittently from a central or peripheral vein catheter for use in the hospital setting.…”

Managing inpatient hyperglycaemia and initiating sodium‐glucose cotransporter 2 inhibitor therapy in the setting of diabetes and acute coronary syndrome

“…In addition to doctors, pharmacists and nurse prescribers may be well positioned to engage in autonomous or collaborative prescribing models to focus on diabetes care. Additionally, new technologies such as continuous glucose monitoring devices can reduce the burden of manual point‐of‐care blood glucose recording 19,20 . Centralised alert systems using networked glucose meters can bring hyperglycaemia, and hypoglycaemia, to the attention of clinicians, thus targeting therapeutic inertia and allow for streamlined benchmarking of glycaemic performance 19,20 .…”

“…Additionally, new technologies such as continuous glucose monitoring devices can reduce the burden of manual point‐of‐care blood glucose recording 19,20 . Centralised alert systems using networked glucose meters can bring hyperglycaemia, and hypoglycaemia, to the attention of clinicians, thus targeting therapeutic inertia and allow for streamlined benchmarking of glycaemic performance 19,20 . A combination of these strategies may be necessary to optimise care for inpatients with diabetes and ACS.…”

Clinical Prediction Tool To Identify Adults With Type 2 Diabetes at Risk for Persistent Adverse Glycemia in Hospital

“…However, it is well accepted that hypoglycemia (defined as glucose <4 mmol/L in Australia and the United Kingdom) and severe hyperglycemia (>15 mmol/L) should be avoided for the safe management of diabetes in hospital. Indeed, benchmarking for AG (glucose <4 or >15 mmol/L) in hospital (8), and implementing interventions to decrease AG have been described elsewhere (9). Hyperglycemia in hospital is common and affects up to 50% of inpatients (10).…”