BACKGROUND: Inpatient hyperglycemia is common and is linked to adverse patient outcomes. New methods to improve glycemic control are needed. OBJECTIVE: To determine whether a virtual glucose management service (vGMS) is associated with improved inpatient glycemic control. DESIGN: Cross-sectional analyses of three 12-month periods (pre-vGMS, transition, and vGMS) between 1 June 2012 and 31 May 2015. SETTING: 3 University of California, San Francisco, hospitals. PATIENTS: All nonobstetric adult inpatients who underwent point-of-care glucose testing. INTERVENTION: Hospitalized adult patients with 2 or more glucose values of 12.5 mmol/L or greater (≥225 mg/dL) (hyperglycemic) and/or a glucose level less than 3.9 mmol/L (<70 mg/dL) (hypoglycemic) in the previous 24 hours were identified using a daily glucose report. Based on review of the insulin/glucose chart in the electronic medical record, recommendations for insulin changes were entered in a vGMS note, which could be seen by all clinicians. MEASUREMENTS: Proportion of patient-days classified as hyperglycemic, hypoglycemic, and at-goal (all measurements ≥3.9 and ≤10 mmol/L [≥70 and ≤180 mg/dL] during the pre-vGMS, transition, and vGMS periods). RESULTS: The proportion of hyperglycemic patients decreased by 39%, from 6.6 per 100 patient-days in the pre-vGMS period to 4.0 per 100 patient-days in the vGMS period (difference, -2.5 [95% CI, -2.7 to -2.4]). The hypoglycemic proportion in the vGMS period was 36% lower than in the pre-vGMS period (difference, -0.28 [CI, -0.35 to -0.22]). Forty severe hypoglycemic events (<2.2 mmol/L [<40 mg/dL]) occurred during the pre-vGMS period compared with 15 during the vGMS period. LIMITATION: Information was not collected on patients' concurrent illnesses and treatment or physicians' responses to the vGMS notes. CONCLUSION: Implementation of the vGMS was associated with decreases in hyperglycemia and hypoglycemia. PRIMARY FUNDING SOURCE: National Institutes of Health, the Wilsey Family Foundation, and the UCSF Clinical & Translational Science Institute.
BACKGROUND: Inpatient hyperglycemia is common and is linked to adverse patient outcomes. New methods to improve glycemic control are needed. OBJECTIVE: To determine whether a virtual glucose management service (vGMS) is associated with improved inpatient glycemic control. DESIGN: Cross-sectional analyses of three 12-month periods (pre-vGMS, transition, and vGMS) between 1 June 2012 and 31 May 2015. SETTING: 3 University of California, San Francisco, hospitals. PATIENTS: All nonobstetric adult inpatients who underwent point-of-care glucose testing. INTERVENTION: Hospitalized adult patients with 2 or more glucose values of 12.5 mmol/L or greater (≥225 mg/dL) (hyperglycemic) and/or a glucose level less than 3.9 mmol/L (<70 mg/dL) (hypoglycemic) in the previous 24 hours were identified using a daily glucose report. Based on review of the insulin/glucose chart in the electronic medical record, recommendations for insulin changes were entered in a vGMS note, which could be seen by all clinicians. MEASUREMENTS: Proportion of patient-days classified as hyperglycemic, hypoglycemic, and at-goal (all measurements ≥3.9 and ≤10 mmol/L [≥70 and ≤180 mg/dL] during the pre-vGMS, transition, and vGMS periods). RESULTS: The proportion of hyperglycemic patients decreased by 39%, from 6.6 per 100 patient-days in the pre-vGMS period to 4.0 per 100 patient-days in the vGMS period (difference, -2.5 [95% CI, -2.7 to -2.4]). The hypoglycemic proportion in the vGMS period was 36% lower than in the pre-vGMS period (difference, -0.28 [CI, -0.35 to -0.22]). Forty severe hypoglycemic events (<2.2 mmol/L [<40 mg/dL]) occurred during the pre-vGMS period compared with 15 during the vGMS period. LIMITATION: Information was not collected on patients' concurrent illnesses and treatment or physicians' responses to the vGMS notes. CONCLUSION: Implementation of the vGMS was associated with decreases in hyperglycemia and hypoglycemia. PRIMARY FUNDING SOURCE: National Institutes of Health, the Wilsey Family Foundation, and the UCSF Clinical & Translational Science Institute.
Authors: Robert J Rushakoff; Joshua A Rushakoff; Zachary Kornberg; Heidemarie Windham MacMaster; Arti D Shah Journal: Curr Diab Rep Date: 2017-09 Impact factor: 4.810
Authors: Martin Röhling; Marcus Redaélli; Dusan Simic; Kristina Lorrek; Christina Samel; Paul Schneider; Kerstin Kempf; Stephanie Stock; Stephan Martin Journal: Diabetes Metab Syndr Obes Date: 2019-11-29 Impact factor: 3.168
Authors: Guillermo Umpierrez; Robert Rushakoff; Jane Jeffrie Seley; Jennifer Y Zhang; Trisha Shang; Julia Han; Elias K Spanakis; Sara Alexanian; Andjela Drincic; Kristen Kulasa; Carlos E Mendez; Damon Tanton; Amisha Wallia; Mihail Zilbermint; David C Klonoff Journal: J Diabetes Sci Technol Date: 2020-08-12