IMPACT OF GLUCOSE MANAGEMENT TEAM ON OUTCOMES OF HOSPITALIZATION IN PATIENTS WITH TYPE 2 DIABETES ADMITTED TO THE MEDICAL SERVICE.
Endocr Pract. 2016 Aug 19;
Authors: Wang YJ, Seggelke S, Hawkins RM, Gibbs J, Lindsay M, Hazlett I, Low Wang CC, Rasouli N, Young KA, Draznin B
Abstract
OBJECTIVE: To improve glycemic control of hospitalized patients with diabetes and hyperglycemia, many medical centers have established dedicated glucose management teams (GMT). However, the impact of these specialized teams on clinical outcomes has not been evaluated.
METHODS: We conducted a retrospective study of 440 patients with type 2 diabetes admitted to the medical service for cardiac or infection-related diagnosis. The primary endpoint was a composite outcome of several well-recognized markers of morbidity, consisting of: death during hospitalization, transfer to ICU, initiation of enteral or parenteral nutrition, line infection, new in-hospital infection or infection lasting more than 20 days of hospitalization, deep venous thrombosis or pulmonary embolism, rise in plasma creatinine, and hospital readmissions.
RESULTS: Medical housestaff managed the glycemia in 79% of patients (usual care), while GMT in 21% of patients (GMT). The primary outcome was similar between cohorts (0.95 vs. 0.99 events per patient in the GMT and usual care cohorts). For sub-analysis, the subjects in both groups were stratified into those with average glycemia of less than 180 mg/dl versus those with over 180 mg/dl. We found a significant beneficial impact of glycemic management by the GMT on the composite outcome in patients with average glycemia >180 mg/dl during their hospital stay. The number of patients who met primary outcome was significantly higher in the usual care group (40 out of 83 patients - 48%) than in the GMT-treated cohort (8 out of 33 patients - 25.7%) (P<0.02).
CONCLUSIONS: Our data suggest that GMT may have an important role in managing difficult to control hyperglycemia in the inpatient setting.
PMID: 27540884 [PubMed - as supplied by publisher]