Hyperglycemia and Length of Stay in Patients Hospitalized for Bone Marrow Transplantation

Garg, Rajesh; Bhutani, Himanshu; Alyea, Edward; Pendergrass, Merri

doi:10.2337/dc06-2563

Cited by 38 publications

(30 citation statements)

References 18 publications

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“…However, the results are consistent with those of other studies linking hyperglycemia to LOS 18,19 and we found no evidence for a temporal trend toward lower LOS on the PACE service as a whole during the same time period. While a greater proportion of patients on the PACE service were in the study in the post-intervention period compared with the preintervention period, we found no evidence that the difference in length of stay was due to increased surveillance for nondiabetics, especially because eligibility criteria depended on phlebotomy glucose values, which were uniformly tested in all inpatients.…”

Section: Discussionsupporting

confidence: 92%

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Schnipper

Ndumele

Liang

et al. 2009

Journal of Hospital Medicine

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BACKGROUND:Inpatient hyperglycemia is associated with poor patient outcomes. It is unknown how best to implement glycemic management strategies in the non–intensive care unit (ICU) setting.OBJECTIVE:To determine the effects of a multifaceted quality improvement intervention on the management of medical inpatients with diabetes mellitus or hyperglycemia.DESIGN:Before‐after trial.SETTING:Geographically localized general medical service staffed by physician's assistants (PAs) and hospitalists.PATIENTS:Consecutively enrolled patients with type 2 diabetes or inpatient hyperglycemia.INTERVENTION:A detailed subcutaneous insulin protocol, an admission order set built into the hospital's computerized order entry system, and case‐based educational workshops and lectures to nurses, physicians, and PAs.MEASUREMENTS:Mean percent of glucose readings per patient between 60 and 180 mg/dL; percent patient‐days with hypoglycemia; insulin use patterns; and hospital length of stay.RESULTS:The mean percent of readings per patient between 60 and 180 mg/dL was 59% prior to the intervention and 65% afterward (adjusted effect size 9.7%; 95% confidence interval [CI], 0.6%‐18.8%). The percent of patient days with any hypoglycemia was 5.5% preintervention and 6.1% afterward (adjusted odds ratio 1.1; 95% CI, 0.6–2.1). Use of scheduled nutritional insulin increased from 40% to 75% (odds ratio 4.5; 95% CI, 2.0–9.9) and adjusted length of stay decreased by 25% (95% CI, 9%‐44%). Daily insulin adjustment did not improve, nor did glucose control beyond hospital day 3.CONCLUSIONS:This multifaceted intervention, which was easy to implement and required minimal resources, was associated with improvements in both insulin ordering practices and glycemic control among non‐ICU medical patients. Journal of Hospital Medicine 2009;4:16–27. © 2009 Society of Hospital Medicine.

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Section: Discussionsupporting

confidence: 92%

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Schnipper

Ndumele

Liang

et al. 2009

Journal of Hospital Medicine

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“…Finally, a study of patients with acute lymphocytic leukemia undergoing induction chemotherapy (not BMT) did show a relationship between in-hospital hyperglycemia (defined as two or more glucose determinations Ͼ200 mg/dl) and infections (relative risk for any infection of 1.28) (P value ϭ 0.009) (1). Similar to results reported by Garg et al (18), our data demonstrate a positive association between hospital length of stay and mean glucose readings performed throughout the entire course of BMT (P value Ͻ0.0001). However, when we focused on the preneutropenic period (before infection onset), we found that hyperglycemia was not associated with an increased length of stay (P ϭ 0.351).…”

Section: Stratification For Diabetes Historysupporting

confidence: 91%

Antecedent Hyperglycemia Is Associated With an Increased Risk of Neutropenic Infections During Bone Marrow Transplantation

2008

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OBJECTIVE -To use bone marrow transplantation (BMT) as a model for testing the association between hyperglycemia and infection.RESEARCH DESIGN AND METHODS -This cohort study included 382 adults (6.5% with diabetes) who had no evidence of infection before neutropenia during BMT. Mean glucose was calculated from central laboratory and bedside measurements taken before neutropenia; the primary outcome was neutropenic infections.RESULTS -Eighty-four patients (22%) developed at least one neutropenic infection, including 51 patients (13%) with bloodstream infections. In patients who did not receive glucocorticoids during neutropenia, each 10 mg/dl increase in mean preneutropenia glucose was associated with an odds ratio of 1.08 (95% CI 0.98 -1.19) (P ϭ 0.14) for any infection and 1.15 (1.03-1.28) (P ϭ 0.01) for bloodstream infections, after adjusting for age, sex, race, year, cancer diagnosis, transplant type, and total glucocorticoid dose before neutropenia. In those who received glucocorticoids during neutropenia (n ϭ 71), the adjusted odds ratio associated with a 10 mg/dl increase in mean glucose was 1.21 (1.09 -1.34) (P Ͻ 0.0001) for any infection and 1.24 (1.11-1.38) (P Ͻ 0.0001) for bloodstream infections. There was no association between mean glycemia and long length of hospital stay, critical status designation, or mortality.CONCLUSIONS -In a BMT population highly susceptible to infection, there was a continuous positive association between mean antecedent glycemia and later infection risk, particularly in patients who received glucocorticoids while neutropenic. Tight glycemic control during BMT and glucocorticoid treatment may reduce infections.

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“…15,16 In contrast to patients with PAD, patients with PADDM spent nearly twice as long in hospital (10 days vs. 15 days). This is in agreement with previous reports, with one particular study from the UK reporting similar lengths of stay for patients without DM versus those with DM who were admitted with peripheral vascular disease and diabetes foot disease (15.5 days vs. 8.7 days).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Diabetes Mellitus on Costs and Length of Stay in Patients with Peripheral Arterial Disease Undergoing Vascular Surgery

Malone

Lau

White

et al. 2014

European Journal of Vascular and Endovascular Surgery

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Hyperglycemia and Length of Stay in Patients Hospitalized for Bone Marrow Transplantation

Cited by 38 publications

References 18 publications

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Antecedent Hyperglycemia Is Associated With an Increased Risk of Neutropenic Infections During Bone Marrow Transplantation

The Effect of Diabetes Mellitus on Costs and Length of Stay in Patients with Peripheral Arterial Disease Undergoing Vascular Surgery

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