The case for supporting inpatient glycemic control programs now: The evidence and beyond

Braithwaite, Susan S.; Magee, Michelle F.; Sharretts, John M.; Schnipper, Jeffrey L.; Amin, Alpesh; Maynard, Gregory

doi:10.1002/jhm.350

Cited by 21 publications

(19 citation statements)

References 78 publications

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“…Over the past two decades, the management of hyperglycemia and diabetes in the inpatient setting has been the focus of many studies and recommendations [1-10]. The extensive data from observational and randomized controlled trials (RCTs) indicating increased risk of complications and mortality, a longer hospital stay, a higher admission rate to the intensive care unit (ICU), and a higher need for transitional or nursing home care after hospital discharge of patients admitted with hyperglycemia and diabetes has led to increased attention on blood glucose control in hospitalized patients [1,11-15].…”

Section: Introductionmentioning

confidence: 99%

Managing hyperglycemia and diabetes in patients receiving enteral feedings: A health system approach

et al. 2015

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Evidence of poor outcomes in hospitalized patients with hyperglycemia has led to new and revised guidelines for inpatient management of diabetes. As providers become more aware of the need for better blood glucose control, they are finding limited guidance in the management of patients receiving enteral nutrition. To address the lack of guidelines in this population, Duke University Health System has developed a consistent practice for managing such patients. Here, we present our practice strategies for insulin use in patients receiving enteral nutrition. Essential factors include assessing the patients’ history of diabetes, hyperglycemia, or hypoglycemia and timing and type of feedings. Insulin practices are then designed to address these issues keeping in mind patient safety in the event of abrupt cessation of nutrition. The outcome of the process is a consistent and safe method for glucose control with enteral nutrition.

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Section: Introductionmentioning

confidence: 99%

Managing hyperglycemia and diabetes in patients receiving enteral feedings: A health system approach

et al. 2015

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“…Despite compelling evidence associating dysglycemia with increased morbidity, mortality, and cost, 9 health care lacks infrastructure and systems to routinely measure and reduce harm from inadequate glycemic control. 7 In 2004 the American College of Endocrinology and the American Association of Clinical Endocrinologists put forth the first recommendations for inpatient glucose management, 10 followed a year later by the inclusion of the first inpatient-oriented recommendations by the American Diabetes Association (ADA).…”

Section: Current State Of Glucose Management Programsmentioning

confidence: 99%

“…9,32–39 Immune system dysfunction, increased oxidative stress, and endothelial dysfunction are hypothesized as the link between hyperglycemia and outcomes. 9 The relationship between blood glucose and adverse outcomes appears to take on a U-shaped curve, with both hypo- and hyperglycemia being associated with preventable harm. A longer LOS predisposes the patient to other complications, such as nosocomial infections, deep venous thrombosis, and poor wound healing.…”

Section: Identification Of Goals For Inpatient Glucose Management Promentioning

confidence: 99%

Modeling Inpatient Glucose Management Programs on Hospital Infection Control Programs: An Infrastructural Model of Excellence

Mathioudakis

Pronovost

Cosgrove

et al. 2015

The Joint Commission Journal on Quality and Patient Safety

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“…[10][11][12] Regardless of this ongoing inquiry, many hospitals have implemented or are moving toward establishing glycemic control programs in an effort to manage inpatient hyperglycemia, particularly in the critically ill. 13,14 These programs are most successful with multidisciplinary involvement; extensive, coordinated, multipronged clinician education; and measurement through quality improvement approaches. 15,16 While some programs have been in place for several years now, reports on the current state of glycemic control in hospitals have demonstrated that considerable opportunity exists for improvement. 17,18 A critical finding from surveys directed at determining current glycemic control practices indicates that most hospitals are, in fact, unable to determine their current glucose metrics [17][18][19] and to measure the impact of their glycemic control programs because the hospitals do not have access to data to track the current state and improvement.…”

Section: Introductionmentioning

confidence: 99%

Benchmarking Glucose Results through Automation: The 2009 Remote Automated Laboratory System Report

Anderson¹,

Zito²,

Kongable

2010

J Diabetes Sci Technol

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Background: Hyperglycemia in the adult inpatient population remains a topic of intense study in U.S. hospitals. Most hospitals have established glycemic control programs but are unable to determine their impact. The 2009 Remote Automated Laboratory System (RALS) Report provides trends in glycemic control over 4 years to 576 U.S. hospitals to support their effort to manage inpatient hyperglycemia. Methods: A proprietary software application feeds de-identified patient point-of-care blood glucose (POC-BG) data from the Medical Automation Systems RALS-Plus data management system to a central server. Analyses include the number of tests and the mean and median BG results for intensive care unit (ICU), non-ICU, and each hospital compared to the aggregate of the other hospitals. Results: More than 175 million BG results were extracted from 2006–2009; 25% were from the ICU. Mean range of BG results for all inpatients in 2006, 2007, 2008, and 2009 was 142.2–201.9, 145.6–201.2, 140.6–205.7, and 140.7–202.4 mg/dl, respectively. The range for ICU patients was 128–226.5, 119.5–219.8, 121.6–226.0, and 121.1–217 mg/dl, respectively. The range for non-ICU patients was 143.4–195.5, 148.6–199.8, 145.2–201.9, and 140.7–203.6 mg/dl, respectively. Hyperglycemia rates of >180 mg/dl in 2008 and 2009 were examined, and hypoglycemia rates of <40 mg/dl (severe) and <70 mg/dl (moderate) in both 2008 and 2009 were calculated. Conclusions: From these data, hospitals can determine the current state of glycemic control in their hospital and in comparison to other hospitals. For many, glycemic control has improved. Automated POC-BG data management software can assist in this effort.

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The case for supporting inpatient glycemic control programs now: The evidence and beyond

Cited by 21 publications

References 78 publications

Managing hyperglycemia and diabetes in patients receiving enteral feedings: A health system approach

Managing hyperglycemia and diabetes in patients receiving enteral feedings: A health system approach

Modeling Inpatient Glucose Management Programs on Hospital Infection Control Programs: An Infrastructural Model of Excellence

Benchmarking Glucose Results through Automation: The 2009 Remote Automated Laboratory System Report

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