Evaluation of an Institution-Wide Guideline for Hyperglycemic Emergencies at a Tertiary Academic Medical Center

Abstract

Background: No previous studies exist examining implementation of an institution-wide guideline and order set for hyperglycemic emergencies (diabetic ketoacidosis [DKA] and hyperosmolar hyperglycemic state [HHS]). Objective: Evaluate the impact of an institutional guideline and order set for hyperglycemic emergencies. Methods: This retrospective descriptive study evaluated patients with a diagnosis of DKA or HHS. Two time periods were evaluated: phase 1 (PRE) assessed practice preguideline implementation, and phase 2 (POST) assessed practice postguideline and order set introduction. Results: A total of 172 patients (91 PRE and 81 POST) were included in the analysis. There was no difference in the mean hospital length of stay (LOS) in the PRE versus POST groups (5.2 ± 4 vs 5.9 ± 8.6 days, P = .49). The mean intensive care unit (ICU) LOS was shorter in the POST group (64.8 ± 19 vs 37.1 ± 74.8 hours, P < .01). The POST group had an increase in frequency of assessments for clearance of urinary ketones (18 vs 33.3%, P = .03) and β-hydroxybutyrate (16 vs 37%, P < .01). Frequency of point-of-care glucose testing (12.5 ± 4.6 vs 15.1 ± 4.7, P < .01) and time to anion gap closure (13 ± 9 vs 9.3 ± 7.4 hours, P < .01) improved in the POST group. There was no difference in the number of patients experiencing hypoglycemia or hypokalemia between both groups. Conclusions: Implementation of an institutional guideline and order set for hyperglycemic emergencies decreased ICU LOS and time to anion gap closure, with no difference in rates of hypoglycemia.