JHM: U.S. academic medical centers need to better manage glucose levels

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At U.S. academic medical centers, glycemic management practices are suboptimal and do not meet current American Diabetes Association (ADA) hospital diabetes care standards, according to a retrospective cohort study published in the January issue of the Journal of Hospital Medicine.

Jeffrey B. Boord, MD, an assistant professor of medicine at Vanderbilt University School of Medicine and Quality Director of the Vanderbilt Heart & Vascular Institute in Nashville, Tenn., and colleagues based the results on a 2005 collaborative project by the University Health System Consortium, an alliance of 103 academic health centers and 119 associated hospitals. A total of 1,718 eligible adult patients met at least one of the study’s inclusion criteria. They assessed three consecutive measurement days of glucose values, glycemic therapy and additional clinical and laboratory characteristics.

In the cohort, 79 percent of patients had a prior diagnosis of diabetes, and 84.6 percent received insulin on the second measurement day.

The researchers found wide variation in performance of the recommended hospital diabetes care measures. Recommendations and guidelines from the ADA include the use of intravenous insulin to control hyperglycemia in critically ill patients, but the study found that intravenous insulin was used in less than half of ICU patients involved in the study.

Boord and colleagues also found that hyperglycemia was common, as 50 percent of all patients had one glucose measurement 180 mg/dL on measurement days two and three. Severe hypoglycemia ( <50 mg/dL) occurred in 2.8 percent of all patient days.

“With the prevalence of diabetes in hospitalized adult patients ranging from 12 to 25 percent, it's vital for hospitals to use effective insulin therapy to control glucose levels in acutely ill patients,” Boord said. "Tight glucose control can improve patient outcomes and decrease hospital stay."

Intravenous insulin use is associated with better overall glucose control in the study, the authors wrote. The findings also indicate the need for more research into other opportunities to improve hospital care practices, such as standardized protocols for subcutaneous basal/bolus insulin regimens and increased frequency of A1C testing.

Despite frequent insulin use, Boord and colleagues said that glucose control was suboptimal. “Academic medical centers have opportunities to improve care to meet current American Diabetes Association hospital diabetes care standards,” according to the authors.