Evaluation of hospital glycemic control at US Academic Medical Centers

Abstract

OBJECTIVE:To evaluate contemporary hospital glycemic management in US academic medical centers.DESIGN: This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics. RESULTS:In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%-63%) and timely admission laboratory glucose measurement (range, 39%-97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose 110 mg/dL.Hyperglycemia was common, 50% of all patients had !1 glucose measurement !180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days. CONCLUSIONS:Despite frequent insulin use, glucose control was suboptimal.

Importance of Perioperative Glycemic Control in General Surgery: A Report from the Surgical Care and Outcomes Assessment Program

“…Another barrier to effective glycemic control may be concerns about insulin administration. Among 37 academic medical centers, recommended regimens of insulin therapy were prescribed in only 45% of patients, 44 and patients with hyperglycemia without a diagnosis of diabetes were less likely to be treated with insulin. 22 We found that 26% of patients with hyperglycemia on the DOS (46% of these being nondiabetic) did not receive insulin.…”

Assessing Inpatient Glycemic Control: What are the Next Steps?

“…8,9 Reports on the status of inpatient glucose control in large samples of hospitals are now available. 10,11 Glucose control is by no means the only component of inpatient hyperglycemia care in need of attention.…”

Obstacles to Optimal Management of Inpatient Hyperglycemia in Noncritically Ill Patients

“…14 mic control with the use of basal insulin, which was attributed to "underdosing" basal insulin or lack of adequate prandial insulin coverage, lack of effective titration in response to hyperglycemia, and variation in the ordering and administration of basal insulin at different hospital sites. 23,24 According to The Endocrine Society's clinical practice guidelines for management of hyperglycemia in the noncritical care setting, checking HbA 1c levels in all inpatients with known diabetes or with hyperglycemia (random blood glucose level . 140 mg/dL) is recommended if this has not been done in the preceding 8 to 12 weeks.…”