Networked glucose meters provide benchmarks for inpatient diabetes care

Networked glucose meters can be used for auditing and benchmarking of safe diabetes care for hospital patients, Victorian researchers say.

In their study, blood glucose levels outside a nominal safe range of 4-15 mmol/L were observed in 260 of 1,000 patient days in medical and surgical patients at a major Melbourne hospital.

Most of the adverse glycaemic days (AGDs) were related to hyperglycaemia (82%), 15% to hypoglycaemia and 3% to both.

The findings, published in the MJA, were part of a 2016 glucometric benchmarking study at the Royal Melbourne Hospital in non-critical wards fitted with networked glucose meters.

The researchers monitored blood glucose in 465 consecutive admissions of 441 people with diabetes or newly detected hyperglycaemia during a 10-week study period. A total of 9,817 blood glucose measurements were made over 2,953 patient-days.

Most patients (85%) had at least one blood glucose measurement over 10 mmol/L; 44% had at least one measurement over 15 mmol/L during their hospital stay.

Hypoglycaemia was less common with 16% of patients having at least one episode <4 mmol/L and 5.8% having a more severe event <3 mmol/L.

Overall there were no AGDs for about half the patient admissions; 26% of patients had 1-2 AGDs and 25% had three or more AGDs.

The mean blood glucose measurement was 9.5 mmol/L and higher in medical than surgical patients (9.7 v 9.2 mmol/L).

Co-author Dr Mervyn Kyi told the limbic that networked glucose meters were the way of the future – allowing for remote monitoring and surveillance of blood glucose levels and timely intervention when required.

“The key here is to do something with the data,” he said.

A randomised controlled trial at the hospital, previously reported in the limbic, had shown that such a model of care could decrease AGDs by about 23%.

As well, the intervention significantly reduced hospital-acquired infections versus usual care.

“The first step now is for all the hospitals to come on board and get these meters connected. The second step is to see what clinical improvement we can do to decrease AGDs.”

He said they developed AGDs – a completely novel concept – as a potential benchmarking figure because there was nothing else.

“I think it will grow in acceptance. The concept here is that days with extremely high or extremely low glucose are bad for you and we should do what we can do to eliminate them.”

“To be safe, the number of AGDs should be zero but it clearly won’t be zero. The more we can minimise it the better,” he said.

“I’m very excited by this in particular because in Australia we really need to document, benchmark and do something about hyper- and hypoglycaemia. And the trouble is that …until you have rates staring you in the face, no one is going to do much about it.”

“That’s the same experience with falls in hospital or Staph sepsis and handwashing in improving hospital-acquired infections. All that clinical improvement happens when you document and benchmark.”

Dr Kyi said a full rollout of networked glucose meters throughout the entire hospital is expected to be completed by late September.

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