Delivery of Guideline Directed Care for Inpatient Glycemic Management: Quality Improvement Implementation

Abstract

Background:

Effective glucose management of hospitalized individuals is essential for improving outcomes such as wound healing and reducing complications including hypoglycemia. There are many models of effective management, including a Virtual Glucose Management Service (VGMS), where a team of diabetes specialists reviews patient data remotely and recommends interventions to optimize glucose management in hospitalized individuals. The objective of our study was to assess the effectiveness of VGMS for glycemic management in hospitalized individuals in a large academic medical center in New York City.

Methods:

We conducted a prospective, quality improvement intervention-control study on individuals ≥ 18 years old with at least one inpatient point-of-care blood glucose (POC BG) value <70 mg/dL and/or > 200 mg/dL admitted to the hospital from January 1, 2022, to December 31, 2023. VGMS was implemented across four intervention units and differences in glycemic outcomes were measured against two control units.

Results:

A total of 1338 individuals were included in the intervention and 1019 individuals were included in the control group. Average glucose values in the control and intervention groups were similar [Mean mg/dL: 174.1 (CI: 172.0, 176.7) vs Mean mg/dL: 175.9 (CI: 173.8, 178.0), P = .1798], however the proportion of individuals with hyperglycemia (POC BG >180 mg/dL) was significantly higher in the control group [72.2% (69.5%, 74.9%) vs 65.5% (63.5%, 67.7%), P ≤ .0001].

Conclusion:

The implementation of a VGMS team significantly reduced hyperglycemia in hospitalized individuals. This study shows that VGMS is an effective and efficient process to implement in hospital settings to improve inpatient glycemic management.