Improving Glucose Management by Redesigning the Care of Diabetic Inpatients Using a Nurse Practitioner Service

Comi, Richard J.; Jacoby, Jeanne L; Basta, Danielle; Wood, Mary M.; Butterly, John R.

doi:10.2337/diaclin.27.2.78

Cited by 3 publications

(5 citation statements)

References 20 publications

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“…Nonphysician providers, such as NPs, are in a position to play a significant role in this process and to overcome the barriers faced in our current health system (Condosta, ). To meet the needs of the diabetes epidemic, NPs are increasingly being trained and practicing as diabetes specialists for both inpatient and outpatient diabetes management (Comi et al., ; Willens et al., ). Our data serve as an example of successful integration of NPs into specialized diabetes teams that improve diabetes management.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have explored the use of specialized NPs in more acute settings where the patient's diabetes would otherwise be managed by a traditional hospital team. Data that do exist in this area demonstrate that NPs, with appropriate support, are successful in serving as diabetes specialists and improving glycemic control in these settings (Comi et al., ). In addition, previous studies on the use of multidisciplinary teams for the purpose of intensified diabetes care suggest that the inclusion of nurse specialists may be not only efficacious, but also cost‐effective in meeting the increasing demands of diabetes care (Willens et al., ).…”

Section: Discussionmentioning

confidence: 99%

“…Good glycemic control before, during, and after surgery has been identified as an important aspect of diabetes care (Comi, Jacoby, Basta, Wood, & Butterly, ). Long‐term hyperglycemia before surgery is also associated with increased risk of complications (Underwood, Askari, Hurwitz, Chamarthi, & Garg, ).…”

Section: Introductionmentioning

confidence: 99%

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Nurse practitioner–mediated intervention for preoperative control of diabetes in elective surgery patients

Garg

Metzger

Rein

et al. 2016

Journal of the American Association of Nurse Practitioners

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Purpose This study evaluated the effect of nurse practitioner (NP) mediated interventions on diabetes control before elective surgery. Data sources A program was initiated to improve preoperative diabetes control in patients with HbA1c > 8%. The intervention was initially mediated by a physician alone and subsequently changed to involve NPs. The goal of intervention was fasting blood glucose (BG) <200 mg/dL on the day of surgery (DOS). Data were collected before the program (control group), during physician‐mediated intervention (phase 1), and during NP‐mediated intervention (phase 2). Conclusions There were 222 patients in the control group, 226 in phase 1, and 160 in phase 2. Mean BG (mg/dL) on DOS was 171.4 ± 66.5 in control group, 162.6 ± 58.1 in phase 1, and 153.4 ± 46.6 in phase 2 (p = NS for control vs. phase 1 and <0.01 for control vs. phase 2). More patients received an intervention in phase 2 (93%) than in phase 1 (75%). Among those receiving intervention, 87% achieved target BG in phase 2 and 82% in phase 1 (p = NS). Duration of diabetes, baseline HbA1c, time available before surgery, and diabetes intervention were independent predictors of achieving target BG. Implications for practice NP‐mediated interventions increased access to care and resulted in lower BG levels and may be a good strategy for preoperative diabetes control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nurse practitioner–mediated intervention for preoperative control of diabetes in elective surgery patients

Garg

Metzger

Rein

et al. 2016

Journal of the American Association of Nurse Practitioners

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“…A few studies 13,14 have examined the impact of GMSs in the care of diabetic patients. Comi et al reported standard deviations (SDs) in glucose readings—a measure of variability or glycemic excursions—among medical patients managed by a GMS compared to those receiving standard in-hospital care delivered by hospitalists.…”

Section: Discussionmentioning

confidence: 99%

“…This study found, as did ours, that patients managed by a GMS had improved glycemic control (SD among GMS patients 60.0 versus SD among those receiving standard care 70.4). 14 While the study by Comi et al was performed in medical patients, DeSantis et al studied the impact of a GMS on surgical patients and also demonstrated that the use of a GMS resulted in substantial improvements in glycemic control, with reduced frequency of hypoglycemia, in patients undergoing a wide variety of surgical procedures. 13 Our study had similar findings, with a significant reduction in mean hospitalization glucose and a significant increase in the percentage of glucose values within target range for patients whose diabetes was managed by the GMS postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Use of a Glucose Management Service Improves Glycemic Control Following Vascular Surgery: An Interrupted Time-Series Study

Wallaert

Chaidarun

Basta

et al. 2015

The Joint Commission Journal on Quality and Patient Safety

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Article-at-a-Glance Background The optimal method for obtaining good blood glucose control in noncritically ill patients undergoing peripheral vascular surgery remains a topic of debate for surgeons, endocrinologists, and others involved in the care of patients with peripheral arterial disease and diabetes. A prospective trial was performed to evaluate the impact of routine use of a glucose management service (GMS) on glycemic control within 24 hours of lower-extremity revascularization (LER). Methods In an interrupted time-series design (May 1, 2011–April 30, 2012), surgeon-directed diabetic care (Baseline phase) to routine GMS involvement (Intervention phase) was compared following LER. GMS assumed responsibility for glucose management through discharge. The main outcome measure was glycemic control, assessed by (1) mean hospitalization glucose and (2) the percentage of recorded glucose values within target range. Statistical process control charts were used to assess the impact of the intervention. Results Clinically important differences in patient demographics were noted between groups; the 19 patients in the Intervention arm had worse peripheral vascular disease than the 19 patients in the Baseline arm (74% critical limb ischemia versus 58%; p = .63). Routine use of GMS significantly reduced mean hospitalization glucose (191 mg/dL Baseline versus 150 mg/dL Intervention, p < .001). Further, the proportion of glucose values in target range increased (48% Baseline versus 78% Intervention, p = .05). Following removal of GMS involvement, measures of glycemic control did not significantly decrease for the 19 postintervention patients. Conclusions Routine involvement of GMS improved glycemic control in patients undergoing LER. Future work is needed to examine the impact of improved glycemic control on clinical outcomes following LER.

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Effectively Identifying the Inpatient With Hyperglycemia to Increase Patient Care and Lower Costs

Mabrey

McFarland²,

Young

et al. 2014

Hospital Practice

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Recent years have seen an increased focus on merging quality care and financial results. This focus not only extends to the inpatient setting but also is of major importance in assuring effective transitions of care from hospital to home. Inducements to meld the 2 factors include tying payment to quality standards, investing in patient safety, and offering new incentives for providers who deliver high-quality and coordinated care. Once seen as the purview of primary care or specific surgical screening programs, identification of patients with hyperglycemia or undiagnosed diabetes mellitus now presents providers with opportunities to improve care. Part of the new focus will need to address the length of stay for patients with diabetes mellitus. These patients are proven to require longer hospital stays regardless of the admission diagnosis. With reducing length of stay as a major objective, efficiency combined with improved quality is the desired outcome. Even with the mounting evidence supporting the benefits of improving glycemic control in the hospital setting, institutions continue to struggle with inpatient glycemic control. Multiple national groups have provided recommendations for blood glucose assessment and glycated hemoglobin testing. This article identifies the key benefits in identifying patients with hyperglycemia and reviews possible ways to identify, monitor, and treat this potential problem area and thereby increase the level of patient care and cost-effectiveness.

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Improving Glucose Management by Redesigning the Care of Diabetic Inpatients Using a Nurse Practitioner Service

Cited by 3 publications

References 20 publications

Nurse practitioner–mediated intervention for preoperative control of diabetes in elective surgery patients

Nurse practitioner–mediated intervention for preoperative control of diabetes in elective surgery patients

Use of a Glucose Management Service Improves Glycemic Control Following Vascular Surgery: An Interrupted Time-Series Study

Effectively Identifying the Inpatient With Hyperglycemia to Increase Patient Care and Lower Costs

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