Poor Glucose Control Impacting Patient Outcomes

By Roberto Colón, MD, system chief medical officer, Premier Health and Theresa Seidenschmidt, bariatric program coordinator, Premier Health

Glycemic management is a consideration across every disease state. Among hospitalized individuals, hyperglycemia, hypoglycemia, and glucose variability are associated with adverse outcomes, including increased morbidity and mortality. Hyperglycemia (a blood glucose greater than 140 mg/dL) and Hypoglycemia a (blood glucose less than 70 mg/dL) are associated with

• increased risk of complications and mortality
• longer hospital stays and higher admission rates to the intensive care unit (ICU)
• higher need for transitional or nursing home care after hospital discharge 
• This includes patients with a diagnosis of diabetes and those without. 

Regulatory bodies such as the Centers for Medicare and Medicaid Services (CMS), National Health Care Safety Network (NHNS) and Leapfrog are beginning to request hospitals share their outcomes. CMS has started collecting data on hospital harm measures, including severe Hyperglycemia and hypoglycemia.  

Premier Health Glycemic Management Committee is a system wide group made up of multiple disciplines from the inpatient and outpatient settings across the health system. The Glycemic Committee aims to improve outcomes through implementing best practices and optimizing glucose control to benefit all patients. This team is leading multiple initiatives related to glucose and glucose control. These initiatives include:

• standardization of patient education
• revision of nursing and PCT education
• revision of system order sets
• implementing  insulin pumps and continuous glucose monitors (CGM) when patients meet certain criteria.

According to the American Diabetes Association (ADA), a long or short acting insulin plan with correction components is the preferred treatment for most noncritically ill hospitalized individuals with adequate nutritional intake. For those with poor oral intake or those who are taking nothing by mouth, basal (long-acting) insulin or a basal plus bolus (short-acting) correction insulin plan is the preferred treatment. Sole use of a correction or supplemental insulin without basal insulin, commonly known as a sliding scale in the inpatient setting, is discouraged as it is associated with poorer outcomes.  

Starting in late June 2024, a Best Practice Advisories (BPA) will fire on the storyboard, alerting providers to two consecutive blood glucose levels above the goal of 180 or below 70. The goal of the BPA is to increase provider awareness of all patients' glucose levels and drive practice change to improve patient outcomes.

In conclusion, we as a system have opportunities to improve glucose management during hospitalization. This requires a multidisciplinary approach and vigilance to achieve better patient outcomes.

Back to the June 2024 issue of Premier Pulse

Source: Standards of Care in Diabetes—2024