Common Models Used for Inpatient Diabetes Management

Drincic, Andjela; Akkireddy, Padmaja; Knezevich, Jon T.

doi:10.1007/s11892-018-0972-x

Cited by 24 publications

(14 citation statements)

References 43 publications

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“…This association may be related to the fact that many thoracic surgery cases were for a malignant tumor, and both lung cancer itself and its treatment have been associated with the development of hyperglycemia [35][36][37] . Traditional inpatient glycemic care is typically passive in nature and not very efficient 14,20,38 . Lack of timely reaction to glucose excursions, delayed treatment, and undiagnosed new onset diabetes or pre-diabetes have all been identified as common factors related to poor inpatient glycemic control 39 .…”

Section: Discussionmentioning

confidence: 99%

Hospital hyperglycemia: Status Investigation and Effect of a Real-time Glycemic Alert System

Cao

Bernet

Liu

et al. 2021

Preprint

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BACKGROUND Hospital hyperglycemia is common and associated with potential adverse outcomes. A Hospital-wide Mobile Phone Alert (HMA) system was built to achieve real time glucose monitoring with warnings for glucose excursions. This study investigated the status of glucose control and evaluated the impact of HMA system on inpatient glycemia management. METHODS Inpatients with hyperglycemia hospitalized between 1 January, 2017 and 31 December, 2018 were identified excluding those < 18 years of age. The HMA system was activated on 1 October, 2017. It sent real time cellphone warning messages to the patient’s designated team physician whenever glucose levels > 10 mmol/L or < 3 mmol/L were detected. A serum glucose > 7.8 mmol/L was defined as hospital hyperglycemia (HH), and > 10 mmol/L was defined as significant HH (SHH). Glucose excursions before and after the HMA system was instituted were compared. RESULTS The incidence of HH, SHH and hypoglycemia was 26.1%, 12.8% and 2.5%, respectively. With the HMA system, the monthly glucose related consultation rate for all inpatients increased 65.9%. The rate of HH glucose amount/ total glucose amount improved with the HMA system, being lower than pre HMA system activation for the surgical wards (15.8 ± 4.7% vs 21.1 ± 6.1%，p<0.05). CONCLUSIONS In this study, one third of inpatients were noted to experience hyperglycemia. Real time cellphone warning messages to the patient’s designated team physician can improve consultation utilization for blood glucose excursions. The alert system was found to reduce the incidence of hyperglycemia on surgical wards.

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Section: Discussionmentioning

confidence: 99%

Hospital hyperglycemia: Status Investigation and Effect of a Real-time Glycemic Alert System

Cao

Bernet

Liu

et al. 2021

Preprint

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“…Implementation of a vGMS with daily suggestions for patients with elevated POC BG values resulted in a nearly 40% decrease in percentage of patients with hyperglycemia (83). For COVID-19 patients with glycemic management issues, a vGMS could be adapted to an active patient Dashboard to allow remote monitoring with suggestion for interventions as needed (84).…”

Section: Diabetes Inpatient Servicesmentioning

confidence: 99%

A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic

Korytkowski

Antinori-Lent

Drincic

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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The pandemic of COVID-19 has presented new challenges to hospital personnel providing care for infected patients with diabetes who represent more than 20% of critically ill patients in intensive care units. Appropriate glycemic management contributes to a reduction in adverse clinical outcomes in acute illness but also requires intensive patient interactions for bedside glucose monitoring, intravenous and subcutaneous insulin administration, as well as rapid intervention for hypoglycemia events. These tasks are required at a time when minimizing patient interactions is recommended as a way of avoiding prolonged exposure to COVID-19 by health care personnel who often practice in settings with limited supplies of personal protective equipment. The purpose of this manuscript is to provide guidance for clinicians for reconciling recommended standards of care for infected hospitalized patients with diabetes while also addressing the daily realities of an overwhelmed health care system in many areas of the country. The use of modified protocols for insulin administration, bedside glucose monitoring, and medications such as glucocorticoids and hydroxychloroquine that may affect glycemic control are discussed. Continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but there are important issues that need to be addressed if these are used in hospitalized patients. On site and remote glucose management teams have potential to provide guidance in areas where there are shortages of personnel who have expertise in inpatient glycemic management.

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“…About one-third of hospitalized patients have a diagnosis of diabetes. 27 Uncontrolled diabetes contributes to increased lengths of stays, delayed procedures, and increased morbidity and mortality for hospitalized patients. Generally, each patient hospitalized with diabetes has the same treatment goals which include providing education, ensuring adequate nutrition, limiting hypoglycemic and hyperglycemic events, and ensuring proper follow-up as an outpatient.…”

Section: The Role Of Clinical Pharmacists For Csii Managementmentioning

confidence: 99%

A guide for the pharmacist's role in insulin pump management during transitions of care

Clements

Castelli

Meade

et al. 2020

J Am Coll Clin Pharm

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In the United States, approximately 12% of the adult population has a diagnosis of diabetes mellitus (DM). Persons with DM are at a higher risk of microvascular and macrovascular complications, as well as hospitalizations, compared with the general population. Over the years, technology for diabetes management has evolved as approximately 350 000 patients are using insulin pump therapy to manage DM. Insulin pump therapy has been shown to improve glycemic control and lower the risk of safety events, such as hypoglycemia. Some studies have shown high compliance with an insulin pump policy among staff members during a hospitalization for a patient with an insulin pump. Other studies have shown improved glycemic control during hospitalization for patients who were managed on an insulin pump from an outpatient endocrinology clinic prior to admission. However, none of the studies involved pharmacy‐ or pharmacist‐led service for insulin pump management during transitions of care. Therefore, we defined the responsibilities of clinical pharmacists, in various roles, regarding insulin pump management in transitions of care. The purpose of this paper is to summarize current evidence for continuous subcutaneous insulin infusion (CSII) in transitions of care, including the use of insulin pumps in the hospital. Opportunities for a pharmacist's role in policies and procedures are also outlined, along with training of clinical pharmacists in this area of practice.

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Common Models Used for Inpatient Diabetes Management

Cited by 24 publications

References 43 publications

Hospital hyperglycemia: Status Investigation and Effect of a Real-time Glycemic Alert System

Hospital hyperglycemia: Status Investigation and Effect of a Real-time Glycemic Alert System

A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic

A guide for the pharmacist's role in insulin pump management during transitions of care

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