The “Why” for Improving Hospital Glycemic Management

DiaTribe Editor, Adam Brown, wrote in a recent article, “We’ve known for a long time that diabetes care in hospitals is often bad, but until you experience it personally – and you have to go to the ER and have an emergency surgery and stay there for five days – you don’t truly understand how unprepared hospitals are.”

For hospitals, being unprepared is usually not an option, and certainly not how you want your patients to think about your organization. But like Adam Brown, countless patients with diabetes have their own similar stories. They may have been being transferred without receiving the necessary insulin or carbohydrates, received the incorrect insulin dose as a result of error-prone paper protocols, or experienced extreme glycemic variability because they were being dosed using sliding scale.

In the age of healthcare consumerism, it may be time to take a hard look at your glycemic management practices and how you can improve diabetes care.

As we covered during our November webinar, Why Inpatient Glycemic Management Matters, there’s no shortage of support for why you should improve inpatient glycemic management.

Carlos Mendez, MD, FACP laid out the scientific evidence:

Hyperglycemia is incredibly common.

• 38% of hospital admissions exhibit hyperglycemia, defined as a fasting blood glucose above 126mg/dL or random blood glucose above 200 mg/dL (Umpierrez, 2002).
• For patients with known diabetes, 78% will have hyperglycemia (Kosiborod, 2007).

High blood glucose leads to infection.

• Hyperglycemia triggers immune dysfunction and increased susceptibility to infection (Clement, 2004).
• A blood glucose of 140 mg/dL or greater was the most important predictor of surgical site infection (Ata, 2010).

Hyperglycemia, hypoglycemia and glycemic variability impact mortality.

• At a blood glucose level of 160 mg/dL, there is an approximate 3-fold increase in mortality compared with 80 mg/dL blood glucose level (Kinsley, 2003).
• Mild hypoglycemia is independently associated with increased risk of mortality in the critically ill (Kinsley, 2011).
• Glycemic variability is a strong, independent predictor of mortality in critically ill patients (Kinsley, 2009) and non-critically ill patients (Mendez, 2013).

Lisa Clement-Bryant, MSN, RN, CDE, CPT of CaroMont Health also shared the impact improved glycemic management can have in your organization. Moving from a paper protocol to EndoTool, they drastically reduced hypoglycemia. They also significantly reduced time to target glucose levels, which reduced length of stay.

The why for improving glycemic management is certainly better outcomes, but at the end of the day it’s ultimately about the patient. The patient deserves better diabetes care, and they soon may be asking more of their healthcare providers.

A new Insulin Nation article is calling for patients with diabetes and their families to be more proactive in asking their hospital about their glycemic management practices. They even provide a checklist to choose their hospital based on their inpatient standard for glycemic care.

As you prioritize your quality initiatives for the year ahead, consider how you would fare on that checklist. Hospitals work hard to ensure that they are providing the highest quality and safest care possible for their patients. With the increasing numbers of individuals in hospitals with diabetes, it makes sense to make improved glycemic management a quality and safety priority.