AHRQ Study Examines Effectiveness of Measures To Control Blood Sugar

An AHRQ-supported study published in the journal Endocrine Practice found that a multidisciplinary intervention was effective in treating uncontrolled hyperglycemia and iatrogenic hypoglycemia among nearly 23,000 patients at an academic medical center. Findings showed consistent improvements in glycemic control over time, ultimately cutting severe inpatient hypoglycemia by more than half, as well as reductions in the length of hospital stays. From 2009 to 2013, AHRQ grantee Greg Maynard, M.D., and colleagues at the University of California, San Diego, studied the effectiveness of the intervention, which included a hypoglycemia reduction bundle (such as order sets and education), daily measurement of glycemic outliers with concurrent intervention, and clinical decision support. The interventions addressed common occurrences that impact glycemic control in hospitals, such as inappropriate insulin prescribing, failure to address unexpected nutritional interruption and failure to respond appropriately to the first hypoglycemic event. “Impact of a Hypoglycemia Reduction Bundle and a Systems Approach to Inpatient Glycemic Management” and theabstract were published online December 22, 2014.

2014 Dec 22:1-34. [Epub ahead of print]

Impact of a Hypoglycemia Reduction Bundle and a Systems Approach to Inpatient Glycemic Management.

Maynard G1, Kulasa K2, Ramos P3, Childers D3, Clay B3, Sebasky M3, Fink E4, Field A4, Renvall M4, Juang PS2, Choe C2, Pearson D5, Serences B5, Lohnes S5.

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Abstract

Objective: Uncontrolled hyperglycemia and iatrogenic hypoglycemia represent common and frequently preventable quality and safety issues. We sought to demonstrate the effectiveness of a hypoglycemia reduction bundle, proactive surveillance of glycemic outliers, and an interdisciplinary data-driven approach to glycemic management.Methods: Population- all hospitalized adult non-critical care (non-ICU) patients with hyperglycemia and / or a diagnosis of diabetes admitted to our 550 bed academic center across five calendar-years (CY).Interventions - hypoglycemia reduction bundle targeting most common remediable contributors to iatrogenic hypoglycemia; Clinical decision support in standardized order sets and glucose management pages; Measure-vention (Daily measurement of glycemic outliers with concurrent intervention by the inpatient diabetes team); Educational programs.Measures and analysis - Pearson chi-square value with relative risks (RRs) and 95% confidence intervals (CI) were calculated to compare glycemic control, hypoglycemia, and hypoglycemia management parameters across the baseline time period (TP1, CY 2009-2010), transitional (TP2, CY 2011-2012), and mature post-intervention phase (TP3, CY 2013). Hypoglycemia defined < 70 mg/dL, severe hypoglycemia < 40 mg/dL, severe hyperglycemia > 299 mg/dL.Results: 22,990 non-ICU patients, representing 94,900 patient-days of observation were included over five year study. The RR TP3:TP1 for glycemic excursions was reduced significantly: hypoglycemic stay, 0.71 (0.65,0.79); severe hypoglycemic stay, 0.44(0.34, 0.58); recurrent hypoglycemic day during stay, 0.78 (0.64,0.94); severe hypoglycemic day, 0.48 (0.37,0.62); severe hyperglycemic day (>299 mg/dL), 0.76 (0.73,0.80).Conclusion: Hyperglycemia and hypoglycemia event rates were both improved, with the most marked effect on severe hypoglycemic events. Most of these interventions should be portable to other hospitals.