Why Inpatient Glycemic Management Matters
Across hospitals, insulin is the most widely prescribed medication, and yet it remains one of the most dangerous drugs. Using complex paper protocols and sliding-scale insulin, hyperglycemia remains common and hypoglycemia episodes occur far too often.
While multiple barriers may stand in the way of optimal glycemic management, achieving and maintaining a target blood glucose while in the hospital matters for your patients and your organization.
Glycemic Management Impacts the Quality, Safety and Cost of Care
It is estimated that one-third of all patients will experience hyperglycemia during their time within the hospital.5 This includes patients who have a diagnosis of diabetes, but also those without preexisting diabetes who experience stress-induced hyperglycemia. Achieving glucose targets among all patients is a critical aspect of delivering quality care. Uncontrolled blood glucose can lead to greater complications, longer length of stay, and increased costs.6
Patients with High Glucose Levels Have Higher Rates of Infection
Research has demonstrated that patients who experience higher glucose levels are at an 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.7
Suggested Reading:
Hyperglycemia and Hypoglycemia is a Concern for Patient Safety
Beyond the risk of infection, serious acute complications can arise quickly from both high and low blood sugars, 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.
Suggested Reading:
- 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 Longer Length of Stay
With the higher risk of infection, slower wound healing and other complications, uncontrolled glucose leads to longer length 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.
Suggested Reading:
- 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)
Hyperglycemia and Hypoglycemia Management is Costly
According to the American Diabetes Association, approximately $71 billion is spent on inpatient diabetes annually,8 and each year 1.5 million individuals are newly diagnosed.9 The cost of inpatient diabetes care is only going to continue to rise if patient’s blood glucose is not managed in the hospital setting. With greater infection, longer length of stay, and increased risk of readmission, uncontrolled blood glucose can be costly.
Suggested Reading:
- 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)