Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care

Jones, Gill; Perry, Colin; Monaghan, Andrew; Kennon, Brian; Sainsbury, Christopher

doi:10.15277/bjdvd.2014.041

Cited by 2 publications

(6 citation statements)

References 7 publications

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“…These data therefore suggest a need for education and raising awareness within the nursing staff within inpatient units. The benefit of such intervention in improving quality of inpatient hypoglycaemia care has been evidenced previously [ 21 ].…”

Section: Discussionmentioning

confidence: 93%

“…As has been reported previously the nationally agreed standard of repeating CBG following measured hypoglycaemia is not being met in the vast majority of patients [ 21 ]. Guidelines suggest identical action for hypoglycaemic CBGs regardless of clinical context.…”

Section: Discussionmentioning

confidence: 99%

“…Of the repeated measurements, less than 10% had a TTR < 15 min and the median TTR was 80 min. As would seem instinctive, a proportional relationship was seen with TTR and severity of initial CBG values [ 21 ].…”

Section: Background and Aimsmentioning

confidence: 99%

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Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia

2016

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AimsInpatient hypoglycaemia is common and associated with adverse outcomes. There is often increased vigilance of hypoglycaemia in inpatients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We aimed to investigate this apparent discrepancy, utilising the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with guidelines stating that CBG should be rechecked following intervention within 15 min of an initial CBG of <4 mmol/L.MethodsThis is an observational study of inpatient CBG data from 8 hospitals over a 7-year period. A national diabetes registry allowed identification of individual’s diagnosis and diabetes therapy. For each initial (index) CBG, the TTR for individuals with T2DM—on insulin or sulphonylurea—was compared with the TTR for individuals with T1DM, using a t test for significance performed on log(TTR). The median TTR was plotted for each group per index CBG.ResultsIn total, 1480,335 CBG measurements were obtained. A total of 26,664 were <4 mmol/L. The TTR in T2DM individuals on sulphonylurea was significantly greater than in T1DM individuals where index CBG was ≥2.3 mmol/L (except index CBG 2.6 mmol/L). For T2DM patients receiving insulin significance exists for index CBGs of ≥3.2 mmol/L.ConclusionsThis analysis suggests that quality of care of hypoglycaemia varies according to diagnosis and medication. The group with the highest TTR (T2DM sulphonylurea treated) are possibly the clinical group in whom hypoglycaemia is most concerning. These data therefore suggest a need for education and raising awareness within the inpatient nursing staff.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia

2016

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“…Previous studies have demonstrated a strong association between the severity of hypoglycemia and TTR. 13,17,20 We evaluated the index POCG as a continuous measure and as a categorical variable according to the International Hypoglycemia Study Group consensus statement as follows: 54 to 70 mg/dL (mild/moderate) and 40 to 53 mg/dL (clinically significant). 27 Consistent with other studies, we considered <40 mg/dL to be severe hypoglycemia.…”

Section: Exposure Variablesmentioning

confidence: 99%

“…9,11,12 Several studies have shown that adherence to the recommendation to repeat a POCG within 15 minutes following hypoglycemia treatment is low. [13][14][15][16][17][18][19][20] Studies have shown a direct association between the hypoglycemic POCG value and the time-to-repeat (TTR) POCG, 13,14,20 indicating that primary healthcare responders (typically nurses) take into account the severity of hypoglycemia in determining the acuity of their response; however, whether patient or hospital factors besides the hypoglycemic POCG value itself are associated with TTR has not been well studied. One study found that median TTR differed by diabetes type and insulin use, but a formal statistical analysis was not provided.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Time-to-Repeat Point-of-Care Glucose Following Hypoglycemic Events in Hospitalized Patients

Abusamaan

Klonoff

Mathioudakis

2019

J Diabetes Sci Technol

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Background: Previous studies have shown low adherence to the recommendation to repeat point-of-care glucose (POCG) within 15 minutes following the treatment of inpatient hypoglycemia. We sought to evaluate whether patient and clinical factors may predict time-to-repeat (TTR) POCG following hypoglycemic events in hospitalized adult patients. Methods: This was a retrospective cross-sectional analysis of 22 226 index hypoglycemic (≤70 mg/dL) readings (of 993 395 total POCG samples) from 6226 hospital admissions within the Johns Hopkins Health System over three years. Time-to-repeat was defined as the difference in time (minutes) between the index POCG and the next POCG sample. Multivariable logistic regression was used to evaluate the association of TTR with clinical, patient, and hospital factors. Results: The median (IQR) TTR was 49 (25-119) minutes, and 14.1% of index POCGs had a TTR ≤15. Severity of hypoglycemia, intensive care unit (ICU), intermediate care (IMC) and pediatrics admissions, and dextrose or glucagon administration were associated with higher adjusted odds of TTR ≤15 minutes. Admission to community hospitals, procedural units, surgery, and labor and delivery was associated with lower adjusted odds of TTR ≤15 minutes. Age, sex, insulin on board, secretagogue use, diabetes type, nutritional status, previous POCG value, and glycemic variability were not significantly associated. Conclusion: There is low adherence to the recommendation to repeat a POCG within 15 minutes following the treatment of inpatient hypoglycemia, which may be mediated by both patient and hospital factors. Further studies are needed to understand the mediators and implications of this practice variability.

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Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care

Cited by 2 publications

References 7 publications

Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia

Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia

Predictors of Time-to-Repeat Point-of-Care Glucose Following Hypoglycemic Events in Hospitalized Patients

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