Background/Aims Diabetes mellitus is increasingly prevalent among hospital inpatients. Management requires regular blood glucose monitoring by nurses, yet research into nurse perceptions of glucose management importance is lacking. Methods A 5-point Likert-scale survey was administered to 718 nurses at an Australian tertiary centre. Nurses were predominantly from acute medical wards (57%) and in the first decade of their career (66%). Results The six tested aspects of glucose monitoring were perceived as important by the majority, but the importance of timely management of abnormal glucose was rated lower by clinical nurse educators (4.33 vs 4.70, P=0.019) and by nurses with 5 or more years of experience compared with first-year nurses. Both predictors remained significant following multivariable adjustment (educator status odds ratio 0.51, P=0.043, years of nursing experience odds ratio 0.84, P=0.018). Conclusions These findings imply that concurrent nurse (re-)education in glucose management should be considered in the design and implementation of future glucose management programmes.
Background/Aims Networked glucose blood monitoring has been demonstrated as a useful process of care for improving glycaemia and clinical outcomes in hospital inpatients. However, these benefits are partly reliant on the accurate entry of patients' medical record numbers by healthcare staff. This study assessed the accuracy of such data entry, comparing the periods before and after the onset of the COVID-19 pandemic. Methods This retrospective observational study analysed glucose meter medical record number entries at a large hospital in Victoria, Australia. The study period spanned from September 2019, when the networked blood glucose monitoring system was introduced, to July 2020. The proportion of inaccurate entries were presented as a percentage of the total number of entries and comparisons were made between the pre-COVID-19 and post-COVID-19 onset periods. Data were analysed using an interrupted time series methodology and presented using a Quasipoisson distribution. Results A gradual decrease in the percentage of accurate medical record number entries was observed following the introduction of the networked blood glucose monitoring system. This decline in accuracy decreased further following the onset of COVID-19, despite the hospital serving a relatively low number of patients with the virus. Conclusions The ongoing decrease in accuracy of data entry into the networked blood glucose monitoring system is thought to be a result of insufficient training and time constraints, which were exacerbated by the COVID-19 pandemic because of protocol changes and furloughed staff. It is recommended that accurate use of the networked blood glucose monitoring system is allocated more regular training in hospital wards.
S75the United States (US). MethodS: The United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model was used to assess the costs (2017 US dollars) and qualityadjusted life-years (QALYs) associated with SGLT2i or GLP-1RA add-on therapy in T2D after metformin failure. The model was run over 3-and 5-year time horizons from a US payer perspective. The UKPDS Outcomes Model predicts diabetes-related outcomes, including: ischemic heart disease, chronic heart failure, amputation, blindness, renal failure, stroke, myocardial infarction, and death. Baseline characteristics were derived from published literature. Simulated hemoglobin A1c (A1C) reductions for the first two years of the model were obtained from long-term outcomes studies and were extrapolated using the model's default algorithm. Costs were obtained from RedBook for drugs and US national sources and published literature for others. Utilities were obtained from published literature. Costs and QALYs were discounted 3% annually. ReSultS: At 5 years, SGLT2i dominated GLP-1RA; SGLT2i cost $66,000 and yielded 3.54 QALYs, whereas GLP-1RA cost $91,000 and yielded 3.54 QALYs. Despite a greater initial reduction in A1C, GLP-1RA had a greater increase in A1C at two years in published clinical trials, which resulted in similar modeled mean A1C values at five years (SGLT2i 7.75% vs. GLP-1RA 7.64%) but higher drug costs. A 3-year time horizon yielded similar results, but the absolute difference in total costs was smaller (SGLT2i $41,000 vs. GLP-1RA $57,000). ConCluSionS: In the short-term, SGLT2i are cost-effective compared to GLP-1RA. Treatment with these agents for a longer time horizon may yield differences in diabetes-related outcomes that may affect their cost-effectiveness, but these differences may not have been captured from a short US payer perspective.
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