Why Inpatient Glycemic Management Matters
Achieving and maintaining optimal blood glucose levels in the inpatient setting is imperative to patient safety and high-quality care. Yet, with continued widespread use of complex paper protocols and sliding-scale insulin, hyperglycemia remains common and hypoglycemia episodes occur far too often.
Glycemic Management Impacts the Quality, Safety and Cost of Care
It is estimated that one-third of all patients will experience hyperglycemia during an inpatient stay.9 This includes patients with a pre-existing diagnosis of diabetes as well as those without diabetes who experience stress-induced hyperglycemia. Achieving glucose targets among all patients is a critical aspect of delivering high-quality care. Uncontrolled blood glucose can lead to greater complications, prolonged lengths of stay and increased costs.10
Patients with Elevated Blood Glucose Levels Have Higher Rates of Infection
Research has demonstrated that patients who experience elevated blood glucose levels are at increased risk of infection. Following general surgery, one study found rates of postoperative infection climbed 30% with every 40-point elevation from normoglycemia (defined as less than 110 mg/dL).11
Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. (Ramos, 2008)
Hyperglycemia and Hypoglycemia are Patient Safety Concerns
Beyond the risk of infection, serious acute complications can arise quickly from both high and low blood glucose levels, and these pose a threat to patient safety. When a patient is experiencing hyperglycemia or hypoglycemia, there is an increased risk of short-term and long-term mortality.
Mortality among hospitalized patients with hypoglycemia: insulin related and noninsulin related. (Akirov, 2017)
Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. (Krinsley, 2003)
Intensive insulin therapy in the medical ICU. (Van den Berghe, 2006)
Uncontrolled Blood Glucose is Associated with Prolonged Lengths of Stay
With higher risk of infection, slower wound healing and other complications, uncontrolled glucose leads to prolonged lengths of stay. Several studies have demonstrated that hyperglycemia can add up to one day to a patient’s length of stay and hypoglycemia can increase length of stay by two and half days.
Eliminating the diabetic disadvantage: The Portland Diabetic Project. (Furnary, 2006)
Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. (Estrada, 2003)
Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. (Turchin, 2009)
Diabetes Management is Costly
According to the American Diabetes Association, approximately $71 billion is spent on inpatient diabetes annually,12 and each year 1.5 million individuals are newly diagnosed.13 The cost of inpatient diabetes care will continue to rise if blood glucose is not managed in the hospital setting. With greater infection, prolonged length of stay and increased risk of readmission, uncontrolled blood glucose is costly.
Economic costs of diabetes in the U.S. in 2017. (American Diabetes Association, 2017)
The relationship between diabetes mellitus and 30-day readmission rates. (Ostling, 2017)