Objectives: Insulin charts represent a key component in the inpatient glycemic management process. The aim was to evaluate the quality of structure, documentation, and treatment of diabetic inpatient care to design a new standardized insulin chart for a large university hospital setting.Methods: Historically grown blank insulin charts in use at 39 general wards were collected and evaluated for quality structure features. Documentation and treatment quality were evaluated in a consecutive snapshot audit of filled-in charts. The primary end point was the percentage of charts with any medication error.Results: Overall, 20 different blank insulin charts with variable designs and significant structural deficits were identified. A medication error occurred in 55% of the 102 audited filled-in insulin charts, consisting of prescription and management errors in 48% and 16%, respectively. Charts of insulin-treated patients had more medication errors relative to patients treated with oral medication (P < 0.01). Chart design did support neither clinical authorization of individual insulin prescription (10%), nor insulin administration confirmed by nurses' signature (25%), nor treatment of hypoglycemia (0%), which resulted in a reduced documentation and treatment quality in clinical practice 7%, 30%, 25%, respectively.Conclusions: A multitude of charts with variable design characteristics and structural deficits were in use across the inpatient wards. More than half of the inpatients had a chart displaying a medication error. Lack of structure quality features of the charts had an impact on documentation and treatment quality. Based on identified deficits and international standards, a new insulin chart was developed to overcome these quality hurdles.
Introduction Diabetes management can be especially complex for older adults who receive health care at home. Thus, international guidelines recommend basal-insulin regimens due to simpler handling and low hypoglycaemia risk. A basal-insulin algorithm (including basal-plus) was developed to also include participant's health status and subsequently implemented into a tablet-based workflow and decision support system, GlucoTab@MobileCare. This study protocol describes a proof-of-concept study to investigate user acceptance, safety and efficacy of the GlucoTab@MobileCare system in participants receiving home health care. Methods The open-label, single-centre, uncontrolled study will recruit a maximum of ten participants with insulin treated type-2-diabetes (age ≥18 years) who receive home health care. During a three month study period participants will receive basal- or basal-plus-insulin therapy once daily as suggested by the GlucoTab@MobileCare system. Statistical analysis will be conducted on an intention-to-treat basis. The primary endpoint is the percentage of tasks (BG measurements, insulin dose calculations, insulin injections) that were performed according to GlucoTab@MobileCare suggestions relative to the total of suggested tasks. Secondary endpoints include user acceptance, safety and efficacy parameters. The study was approved by the ethics committee and regulatory authorities. Before obtaining written informed consent, all participants will receive oral and written information about all aspects of the study. Results will be published in a peer-reviewed journal and at diabetes and geriatric conferences. Discussion Potential implications may be improved quality and safety of basal-insulin therapy in older adults as well as support for health-care-providers in daily routine including evidence-based knowledge. Trial registration German Clinical Trials Register (DRKS00015059);
Aim of this study was to evaluate the accuracy and usability of a novel continuous glucose moni-toring (CGM) system designed for needle-free insertion and reduced environmental impact. We assessed sensor performance of two GlucoMen® Day CGM systems worn simultaneously in eight participants with type 1 diabetes. Self-monitoring of blood glucose (SMBG) was performed reg-ularly over 14 days at home. Participants underwent two standardized 5-hour meal challenges with frequent plasma glucose (PG) measurements using a laboratory reference instrument at the research center. When comparing CGM to PG the overall mean absolute relative difference (MARD) was 9.7 [2.6-14.6]%. The overall MARD of CGM vs SMBG was 13.1 [3.5-18.6]%. In the consensus error grid (CEG) analysis, 98% of both CGM/PG and CGM/SMBG pairs were in the clinically acceptable zones A and B. The analysis confirms that GlucoMen® Day CGM meets the clinical requirements for state-of-the-art CGM. The needle-free insertion technology is well toler-ated by users and reduces medical waste compared to conventional CGM systems.
Background: GlucoTab, an electronic diabetes management system (eDMS), supports healthcare professionals (HCPs) in inpatient blood glucose (BG) management at point-of-care and was implemented for the first time under routine conditions in a regional hospital to replace the paper insulin chart. Method: To investigate quality of the eDMS for inpatients with type 2 diabetes mellitus a monocentric retrospective before-after evaluation was conducted. We compared documentation possibilities by assessing a blank paper chart vs the eDMS user interface. Further quality aspects were compared by assessing filled-in paper charts ( n = 106) vs filled-in eDMS documentation ( n = 241). HCPs ( n = 59) were interviewed regarding eDMS satisfaction. Results: The eDMS represented an improvement of documentation possibilities by offering a more structured and comprehensive user interface compared to the blank paper chart. The number of good diabetes days averaged to a median value of four days in both groups (paper chart: 4.38 [0-7] vs eDMS: 4.38 [0-7] days). Median daily BG was 170 (117-297) mg/dL vs 168 (86-286) mg/dL and median fasting BG was 152 (95-285) mg/dL vs 145 (69-333) mg/dL, and 0.1% vs 0.4% BG values <54 mg/dL were documented. Diabetes documentation quality improved when using eDMS, for example, documentation of ordered BG measurement frequency (1% vs 100%) and ordered BG targets (0% vs 100%). HCPs stated that by using eDMS errors could be prevented (74%), and digital support of work processes was completed (77%). Time saving was noted by 8 out of 11 HCPs and estimated at 10-15 minutes per patient day by two HCPs. Conclusions: The eDMS completely replaced the paper chart, showed comparable glycemic control, was positively accepted by HCPs, and is suitable for inpatient diabetes management.
Introduction: Glycemic management can be complex in elderly patients despite of multimorbidity and polypharmacy. International guidelines recommend individualizing therapy goals by using easy to handle basal insulin regimen with low hypoglycemia risk. An algorithm for basal insulin therapy (including basal-plus) based on the individual’s health status was developed and incorporated into GlucoTab®. This tablet-based workflow and decision support system provides suggestions for insulin therapy, blood glucose (BG) management and offers workflow support by visualization of open tasks. The study objective was to investigate efficacy and safety of the GlucoTab® system in patients at an acute geriatric hospital. Methods: A randomized controlled trial was performed in 58 patients with type 2 diabetes aged ≥ 65 years. Patients in the intervention group (IG) (n=31) were treated according to GlucoTab® basal insulin algorithm, patients in the control group (CG) (n=27) received diabetes therapy according to physician’s prescription electronically documented in GlucoTab®. Results: Patients of both groups (sex: IG=65% vs. CG=63% females, age: 78±6 vs. 76±6 years, BMI: 29±6 vs. 30±6 kg/m2 and HbA1c: 56±10 vs. 61±13 mmol/mol) were attributed an individual health status: 74% moderate and 26% good health. The percentage of fasting BG (FBG) values within health-dependent FBG target range was 59±33% vs. 51±31%. BG values below, within, and above health dependent target range occurred in 4%, 75% and 22% vs. 1%, 75% and 25%, respectively. In both groups no severe hypoglycemic event <40 mg/dl was observed. The number of BG values in the ranges 40 to 69 mg/dl was 3 vs. 2, respectively. Mean FBG was 142±49 vs. 150±38 mg/dl and mean daily BG was 195±74 vs. 201±46 mg/dl. Conclusion: The GlucoTab® basal insulin algorithm supported an efficacious and safe glycemic management in patients with type 2 diabetes in acute geriatric care. Disclosure A. Libiseller: None. K.M. Lichtenegger: None. J. Kopanz: None. A. de Campo: Advisory Panel; Self; Sanofi-Aventis. T. Wiesinger: Other Relationship; Self; Bristol-Myers Squibb Company. L. Weidinger: None. L. Laubreiter: None. W. Schippinger: None. T. Truskaller: None. B.C. Lackner: None. P. Beck: Employee; Self; decide Clinical Software GmbH. Stock/Shareholder; Self; decide Clinical Software GmbH. B. Höll: Employee; Self; decide Clinical Software GmbH. T.R. Pieber: Advisory Panel; Self; ADOCIA, Arecor Limited, AstraZeneca, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; Novo Nordisk A/S. Funding Austrian Research Promotion Agency (FFG844737)
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