Management of diabetes by a healthcare team in a cardiology unit: a randomized controlled trial

Moraes, Maria Antonieta; Rodrigues, Juliane Tavares; Cremonesi, Mariana Barroso; Polanczyk, Carísi Anne; Schaan, Beatriz D.

doi:10.6061/clinics/2013(11)03

Cited by 7 publications

(7 citation statements)

References 23 publications

(27 reference statements)

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“…Their results were similar to our study, with similar mean capillary BGL during hospitalisation between the two groups (9.8 ± 2.9 mmol/L vs 9.1 ± 2.4 mmol/L, P = .078). The number of hypoglycaemic episodes ( P = .77), hyperglycaemic episodes ( P = .35) and LOS ( P = .64) were also similar in both the groups . A before and after study by Wong.B et al used computerised insulin order sets for inpatient glycaemic control in a non‐intensive care setting.…”

Section: Discussionmentioning

confidence: 83%

“…We also experienced resistance in the uptake of guidelines from the cardiology cohort as they perceived it as an additional work load on the junior medical staff and also a hindrance to speedy discharge of patients. The high turnover of medical residents and registrars decreased the efficiency of the guidelines and affected the results across both the CTS and ACS cohorts . Although intensive education was provided periodically to medical residents, registrars and the nursing staff by the endocrine team, diabetes input was only available during weekday business hours to assist with the management of glycaemic control.…”

Section: Discussionmentioning

confidence: 99%

“…The high turnover of medical residents and registrars decreased the efficiency of the guidelines and affected the results across both the CTS and ACS cohorts. 16 Although intensive education was pro- (95% CI 0.89-1.59, P = .24) for death. Contrary with our study, a post-hoc analysis showed increased risk of hypoglycaemic episodes (RR 6.92, 95% CI 2.04-23.41), P = .002) with intensive control.…”

Section: Key Findingsmentioning

confidence: 98%

“…A possible explanation for the results of our study, particularly in the ACS cohort, is the predominant focus of our institution on speedy resolution of the primary cardiac problem followed by a rapid discharge because of high bed pressure. 16,17 Glycaemic control is viewed as a non-urgent issue, which is mostly left for the patient's general practitioners to review after discharge from hospital. This led to a rapid turnover of ACS patients and lack of implementation of the guidelines.…”

Section: Key Findingsmentioning

confidence: 99%

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Glycaemic optimization for patients with cardiac disease-A before-and-after study

et al. 2018

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Key Findingsmentioning

confidence: 98%

Section: Key Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Glycaemic optimization for patients with cardiac disease-A before-and-after study

et al. 2018

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“…The timely consultation of glycemic management teams has also been found to improve the quality of care provided, reduce the length of hospital stay and lower costs (107,108), although differences in glycemic control were minimal (109). Deployment of nurses (110,111), nurse practitioners and physician assistants (112) with specialty training has been associated with greater use of basalbolus insulin therapy and lower mean BG levels.…”

Section: Interprofessional Team-based Approachmentioning

confidence: 99%

In-Hospital Management of Diabetes

Malcolm¹,

Halperin²,

Miller³

et al. 2018

Canadian Journal of Diabetes

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is common in hospitalized people, even among those without a previous history of diabetes, and is associated with increased in-hospital complications, longer length of stay and mortality. • Insulin is the most appropriate pharmacologic agent for effectively controlling glycemia in hospital. A proactive approach to glycemic management using scheduled basal, bolus and correction (supplemental) insulin is the preferred method. The use of correction-only (supplemental) insulin, which treats hyperglycemia only after it has occurred, should be discouraged as the sole modality for treating elevated blood glucose levels. • For the majority of noncritically ill hospitalized people with diabetes, preprandial blood glucose targets should be 5.0 to 8.0 mmol/L, in conjunction with random blood glucose values <10.0 mmol/L, as long as these targets can be safely achieved. For critically ill hospitalized people with diabetes, blood glucose levels should be maintained between 6.0 and 10.0 mmol/L. • Hypoglycemia is a major barrier to achieving targeted glycemic control in the hospital setting. Health-care institutions should develop protocols for the assessment and treatment of hypoglycemia. KEY MESSAGES FOR PEOPLE WITH DIABETES • If your admission to hospital is planned, talk with your health-care providers (e.g. surgeon, anesthetist, primary care provider, diabetes health provider, etc.) before you are admitted in order to develop an in-hospital diabetes care plan that addresses such issues as: • Who will manage your diabetes in the hospital? • Will you be able to self-manage your diabetes? • What adjustments to your diabetes medications or insulin doses may be necessary before and after medical procedures or surgery? • If you use an insulin pump, are hospital staff familiar with pump therapy? • Your blood glucose levels may be higher in hospital than your usual target range due to a variety of factors, including the stress of your illness, medications, medical procedures and infections. • Your diabetes medications may need to be changed during your hospital stay to manage the changes in blood glucose, or if medical conditions develop that make some medications no longer safe to use. • When you are discharged, make sure that you have written instructions about: • Changes in your dosage of medications or insulin injections or any new medications or treatments • How often to check your blood glucose • Who to contact if you have difficulty managing your blood glucose levels. Screening for and Diagnosis of Diabetes and Hyperglycemia in the Hospital Setting A history of diabetes should be elicited in all patients admitted to hospital and, if present, should be clearly identified on the medical record. In view of the high prevalence of inpatient hyperglycemia with associated poor outcomes, an admission BG measurement of all patients would help identify people with diabetes, even in the absence of a prior diagnosis (1,5). In-hospital hyperglycemia is defined as any glucose value >7.8 mmol/L. For hospitalized people with known diabetes,...

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Effectiveness of a multi-component quality improvement intervention on rates of hyperglycaemia

et al. 2017

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PurposeTo evaluate the effectiveness of a multifaceted, hospital-wide glycaemic control quality improvement programme.MethodsThe quality improvement intervention comprised three components, derived through root cause analysis: standardising and simplifying care (including evidence-based order sets), increasing visibility (through provider access to clinical data and direct feedback) and educational outreach (directed at the entire institution). Effectiveness was determined at a single urban acute care hospital through time-series analysis with statistical process control charts. Primary outcomes included rate of hyperglycaemia and rate of hypoglycaemia.ResultsThe study included 70 992 hospital admissions for 50 404 patients, with 3 35 645 patient days. The hyperglycaemia ratio decreased 25.2% from 14.1% to 10.5% (95% CI 3.3 to 3.9 percentage points, p<0.001). The ratio of patient days with highly elevated blood glucose (>299 mg/dL) decreased 31.8% from 4.8% to 3.3% (95% CI 1.4 to 1.7 percentage points, p<0.001). Hypoglycaemia ratio decreased from 5.2% to 4.6% (95% CI 0.27 to 0.89 percentage points, p<0.001) in patients with diabetes, but increased in patients without diabetes from 1.2% to 1.7% (95% CI 0.46 to 0.70 percentage points, p<0.001).ConclusionsWe demonstrate improved hospital-wide glycaemic control after a multifaceted quality improvement intervention in the context of strong institutional commitment, national mentorship and Lean management

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Management of diabetes by a healthcare team in a cardiology unit: a randomized controlled trial

Cited by 7 publications

References 23 publications

Glycaemic optimization for patients with cardiac disease-A before-and-after study

Glycaemic optimization for patients with cardiac disease-A before-and-after study

In-Hospital Management of Diabetes

Effectiveness of a multi-component quality improvement intervention on rates of hyperglycaemia

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