Location in Hospital Plays Large Part in Glycemic Control
High blood sugar can result from hypothermia, which may be induced to improve neurologic outcome in unconscious patients. Certain patient populations, such as post-cardiac and post-cardiothoracic surgery, in particular, are particularly vulnerable to the effects of hyperglycemia.
The evidence of a link between hyperglycemia and increased morbidity and mortality began emerging as early as the mid-1980s. While the results of some studies have clouded the issue, one consistent theme continues to emerge. Location, location, location. For patients in intensive care, post-operative and trauma units or anyone who is critically ill, glycemic control is important, while in lower acuity areas, the impact of blood glucose level seems less significant. One major reason for this link also is clear. High blood glucose levels repress immune response, delaying healing and leading to increased infection rates.
Hypoglycemia is also emerging as a significant risk factor for patients. In fact, some studies that have failed to find benefits for glucose management programs may actually reflect the lack of precision of the blood sugar management process. Specifically, they reflect the negative effects of patient hypoglycemia, an unfortunate byproduct of today’s glucose management protocols, as nurses struggle and rely on guesswork to adjust insulin to the correct level.
After reviewing the evidence, both the American Diabetes Association and the Institute for Healthcare Improvement advocate intensive monitoring of glucose levels for certain hospitalized patients.
In addition to patient outcomes, today’s financial incentives make glucose control a priority. The Centers for Medicare and Medicaid Services view complications arising from suboptimal blood glucose levels as a “hospital-acquired condition,” and treatment is not a covered expense. Patient care costs also can be lowered through minimizing length of stay in the ICU and hospital overall as well as infections and other complications as part of a glucose management program.