In-Hospital Glucose Monitoring: Adequacy and Resource Management
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 5, Issue 5
Abstract
Adequate capillary glucose monitoring in the inpatient population is of crucial importance, as poor glucose control is associated to higher morbidity and mortality. In our experience, this practice does not always parallel clinical urgency, nor is it correlated to an immediate intervention leading to a treatment modification. We analyzed all capillary glucose data documented in the Electronic Medical Records of all hospitalized patients (excluding intensive care patients) during the first semester of 2015. Subsequently, a glucose monitoring protocol was devised, based on inpatient clinical characteristics, which we shared with medical and nursing staff with the aim of optimizing resources and standardizing measurement practices in our hospital. All capillary glucose was analyzed in the first semester of 2016 after adopting the proposed protocol. Less hypoglycemic episode was founded. Sensitizing and educating staff on the topic of glycemia may lead to clinical improvements, potentially reducing the risk of infection, as well as reducing the duration of hospitalization and impacting clinical management positively in a comprehensive manner. An adequate and systematic utilization of capillary glucose data as decisional aid tool, eventually to be integrated with an ‘alert’ system, may become a valid pillar of support in the planning and improvement of inpatient care available to healthcare professionals. According to the 2010 ISTAT report diabetes (type 1 and 2) is documented as primary or secondary diagnosis in 6% of the inpatient population [1]. The prevalence of diabetes can however significantly vary across different units. For instance, emergency ward inpatients display a higher prevalence of approximately 22-24% [2,3]. Another study conducted in 2014 in Italy suggests that approximately 23% of diabetic patients are hospitalized at least once a year compared to 11% of unaffected subjects [4]. Among health care expenditures attributable to metabolic disease the hospitalization of diabetic subjects produces the highest costs [5,6]. Hyperglycemias at admission, regardless of previous diagnosis of diabetes, is associated to higher morbidity and mortality across all areas of care [7,8]. Glucose monitoring in these patients or in patients at risk of developing hyperglycemias is therefore crucial. A recent metanalysis involving aprox. 15 important studies confirmed that adequate blood glucose control (< 150mg/dl or 8.3mmol/L) featuring the use of specific protocols in the preoperative setting significantly reduced the risk of surgical infections [9] and that a radical intervention aimed at correcting hyperglycaemia in subjects at risk resulted in lower mortality and morbidity [10]. There are numerous studies and validated glucose managing protocols for the management of critical care patients (ranging from the DIGAMI study to more recent observations in CRIT CARE). However, little is known about the management of diabetic patients in regular wards. Aim of Study There is a lack of capillary glucose monitoring protocols for the management of hospitalized patients containing precise and strict instructions related to pathology (diabetes) and individual therapy in scientific literature. According to SID-AMD 2016 guidelines for patients in stable conditions, who are not receiving oral nutrition measurement intervals of indicatively 4 to 6 hours, are acceptable [11]. In contrast, patients feeding orally require measurements before meals and before sleep, as well as the possibility of adding postprandial and nightly measurements too. Intermittent, occasional measuring practices followed by insulin administration ‘as required’ in that moment (sliding scale) are to be avoided because considered inadequate and inefficient [12]. In all patients not considered diabetic but who are receiving treatments that entail a hyperglycaemic risk (such as high dosage steroids, enteral or parenteral nutrition, drugs like octreotide or immunosuppressant’s) glucose monitoring must be recommended in order to potentially supply corrective insulin injections or to implement a basal-bolus scheme in case of persisting hyperglycaemias.
Authors and Affiliations
Cesare Berra, Elena Azzolini, Federico Zangrandi, Marco Mirani, Francesco De Fazio, Giuseppe Favacchio, Nicole Mauer, Patrizia Meroni
Keywords
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- EP ID EP591842
- DOI 10.26717/BJSTR.2018.05.001273
- Views 176
- Downloads 0
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