Background: Diabetes Mellitus is a growing concern in the USA, affecting around 10.5% of the population or approximately 34.2 million people. West Virginia has the highest prevalence of adult diabetes, with 16.2% of the population diagnosed in 2018. In noncritical care hospitalized patients, new-onset hyperglycemia and patient with diabetes make up 25-30% of the census. The financial burden of diabetes is staggering as well, with the disease costing over $327 billion in the USA. Both diabetes and hyperglycemia in the inpatient setting are associated with poor outcomes, such as prolonged hospital stays and increased post-operation complications. A uniform protocol for managing inpatient hyperglycemia in the noncritical care setting is warranted to ensure safe blood glucose control while avoiding hypoglycemic episodes.
Methods: Before implementing our protocol, we gathered information from patients admitted to the Marshall Internal Medicine teams, to evaluate the level of glycemic control in the inpatient setting. The data collected from 30 patients, with a total of 490 blood glucose (BG) readings, revealed that 62% of the patients had BG levels above 180 mg/dl, while only 38% of the patients had BG levels within the target range of 140-180 mg/dl. The percentage of hypoglycemic readings was 2%.Our project involved implementing a protocol for glycemic care, with monitoring improvement through Plan-Do-Study-Act (PDSA) model. Each PDSA cycle lasts four weeks. At the beginning of each cycle, we provided a brief education session to new residents. Throughout each cycle, we retrospectively collected data on the types and regimens of insulin prescribed and the patient’s blood glucose readings, including fasting, pre-lunch, pre-dinner, and bedtime readings. We recorded readings for at least three consecutive days.At the end of each cycle, we analyzed the percentage of glycemic control. We also recorded the percentage of hypoglycemic readings and investigated the root cause of each episode.
Results: Two months after implementing our protocol, the percentage of blood glucose (BG) readings within the target range of 140-180 mg/dl was 65%, while the percentage of BG readings above 180 mg/dl was 35%, which means there was a 27% decrease in hyperglycemic episodes. Additionally, there were also only two episodes (< 1% of BG readings) of hypoglycemic readings, with BG levels between 50-70 mg/dl.
Conclusions: Appropriate inpatient glycemic management limits the risks of severe hypoglycemia and hyperglycemia. Preventing and treating hyperglycemia reduces infections and minimizes fluid and electrolyte abnormalities. Our project yielded promising results, demonstrating the importance of implementing and educating all healthcare professionals on institution-specific guidelines and protocols. Our goal was to improve glycemic control by 20%, which was exceeded by a 27% improvement by the end of the second PDSA cycle.