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DAILY INPATIENT GLYCEMIC SURVEY (DINGS). A PROCESS TO REMOTELY IDENTIFY AND ASSIST IN THE MANAGEMENT OF HOSPITALIZED PATIENTS WITH DIABETES AND HYPERGLYCEMIA.
Endocr Pract. 2015 Jun 29;
Authors: Mendez CE, Ata A, Rourke JM, Stain SC, Umpierrez G
Abstract
OBJECTIVE: Hyperglycemia, hypoglycemia, and glycemic variability have been associated with increased morbidity, mortality, and overall costs of care in hospitalized patients. At the Stratton VA Medical Center, in Albany, NY, a process aimed to improve inpatient glycemic control by remotely assisting primary care teams in the management of hyperglycemia and diabetes was designed.
METHODS: An electronic query comprised of hospitalized patients with glucose values below 70mg/dL or above 350mg/dL is generated daily. Electronic medical records are individually reviewed by diabetes specialist providers and management recommendations are sent to primary care teams when applicable. Glucose data was retrospectively examined before and after the establishment of the DINGS process and rates of hyperglycemia and hypoglycemia were compared.
RESULTS: Patient-day mean glucose slightly decreased from 177.6 ± 64.4 mg/dL to 173.2 ± 59.4 mg/dL, P < 0.001. The percentage of patient-days with any value over 350 mg/dL also decreased from 9.69% to 7.36% (P < 0.001), while the percentage of patient-days with mean glucose values in the range of 90 to 180 mg/dL increased from 58.1% to 61.4% (P < 0.001). Glycemic variability, assessed by the standard deviation of glucose, significantly decreased from 53.9 mg/dL to 49.8 mg/dL (P < 0.001). Moreover, rates of hypoglycemia (< 70 mg/dL) decreased significantly by 41% (P < 0.001).
CONCLUSION: Quality metrics of inpatient glycemic control improved significantly after the establishment of the DINGS process within our facility. Prospective controlled studies are needed to confirm a causal association.
PMID: 26121456 [PubMed - as supplied by publisher]