This article originally appeared in HIT Consultant.
It’s no secret hyperglycemia and hypoglycemia are associated with adverse outcomes in hospitalized patients. We’ve known for many years that hyperglycemia is widespread in the hospital, causes immune dysfunction, higher rates of infection, a longer length of hospital stay, complications, and even death.
Insulin has been the most effective therapy for hyperglycemia since it was first created almost 100 years ago, but it can also be dangerous if not managed properly. In fact, nearly 50% of all medication errors in the hospital involve insulin, including 33% of all fatal medication errors.
Insulin doses must be carefully tailored to each patient’s individual needs. Too much insulin can cause severe hypoglycemia, which can lead to brain fuel deprivation, seizure, coma, and brain death1.
Glycemic issues and their associated complications are incredibly frequent, costly, and severe. They’re also largely preventable. Insulin dosing decision support software is becoming an increasingly important factor in enabling hospitals to deliver the proper, personalized care that patients deserve.
To understand the impact glycemic management can have, hospitals first need to remember it’s an issue that touches a substantial percentage of patients. It’s estimated that 25-30% of all hospitalized patients are living with diabetes and many of these patients are above their glycemic goal level.
Hyperglycemia also occurs in patients without diabetes, the result of complex pathophysiology and the body’s response to stress, worsened by the fact that critically ill patients may also receive one of hundreds of medications known to affect blood glucose levels2. This phenomenon can also manifest in similar adverse outcomes as higher rates of infection, complications, longer length of hospital stay, and death3. More than 30% of all critically ill patients in the hospital will need insulin therapy during their stay.
For the past 20 years, organizations such as the American Diabetes Association and the American Association of Clinical Endocrinologists have issued calls to action advocating for better in-patient glycemic management. But large scale change has still not taken place. Roughly 90% of hospitals still rely on outdated, generic, one-size-fits-all “sliding-scale” protocols to treat hyperglycemia. These insulin protocols and pocket-cards aim to aid clinicians in determining appropriate insulin doses for hospitalized patients; however, this approach has been error-prone, difficult to scale, and is not able to be individualized for each patient.
Today, electronic support tools such as Continuous Glucose Monitoring (CGM) and electronic Glycemic Management Systems (eGMS) are becoming increasingly valuable for the management of hyperglycemia.
Outside the hospital setting, CGM has enabled patients to replace manual finger-stick glucose measurement with a wearable sensor that can continuously send real-time glucose data to a patient’s mobile phone. In response to the COVID-19 pandemic, FDA announced in March that it would allow CGM to be used for remote glucose monitoring in the hospital for the duration of the national health emergency.
Revolutionizing the way hospital glucose is managed can drastically improve the quality of care. All health systems should consider electronic support tools for glycemic management. Here are five reasons why:
- Improved Time-in-Range: Using insulin dosing software such as eGMS, critically ill patients on IV insulin typically see complete resolution of hyperglycemia within a few short hours. Prompt, precise, and appropriate control of glucose is associated with improved patient outcomes.
- Shorter hospital stays: Diabetes and poor glucose control can lead to patient stays that are 2-3 days longer than patients without hyperglycemia. Support tools like eGMS can help monitor and deliver treatment plans that improve health outcomes and shorten stays. Patients can return to their lives more quickly and providers can spend more time treating others while also freeing valuable bed space in their facilities.
- Reduced costs: One in every five healthcare dollars and one of every three Medicare dollars are spent on people living with diabetes. At the hospital level, research suggests a single hypoglycemic episode of 40 ml/dl or lower can cost up to $10,000. By giving providers the ability to identify and control glycemic issues with more precision, electronic support tools can significantly lower costs by reducing patient hospital stays and minimizing the potential for additional complications.
- Personalized care: The American Diabetes Association 2020 Standards of Medical Care in Diabetes explains practitioners should create individualized insulin therapy programs and utilize technology to standardize support. Simply put, the personalized care that patients need cannot be provided with manual, one-size-fits-all, sliding scale methods. eGMS, on the other hand, can be tightly integrated with electronic medical records and can leverage the vast amount of readily available patient-specific data to individualize insulin dosing for patients.
- Standardized and simplified workflows: Digital health tools have the power to collect patient data, analyze it, make personalized recommendations, and synthesize dosing information. This automates previously manual, time-consuming, and error-prone processes to ease the amount of time providers spend monitoring blood glucose levels and calculating insulin doses, which can, in turn, reduce burnout and miscalculations. This technology can also help hospitals standardize procedures, eliminating variations between doctors, nurses, and other providers.
We can no longer ignore how costly, both in terms of finance and health, improper glycemic control is for patients and health systems at large. Poor glycemic management has been known to raise the risk of infection, increase the length of hospital stays, and risk of complications. The monetary impact is very real, too – research shows severe hypoglycemia events cost the healthcare industry anywhere from $10 to $14 billion a year.
eGMS efficiency, accuracy, and cost-saving capabilities can no longer be ignored. By removing the need for providers to rely on dated, manual protocols and monitoring processes, digital support tools can enable providers to offer better, more personalized care that delivers substantial impact on outcomes and the bottom line.