Insulin, Diabetes, CMS Measure, Glycemic Management

Diabetes Awareness Month: A Call for Better Inpatient Care

Hospitals should provide peace of mind during a crisis or major life event. Whether we need treatment after an accident, routine surgery, are planning to deliver a baby or countless other reasons for a visit, we take comfort knowing we’re in the right place with clinicians who are well trained to provide the care we need. Unfortunately, this isn’t a universal feeling for every patient.

During Glytec’s Time to Target conference, Amy Tenderich, founder and editor-in-chief of DiabetesMine, and a Glytec scientific advisory board member, detailed the unfortunate reality people living with diabetes face in the inpatient setting:

“It can be a very frightening experience to be hospitalized with type 1 diabetes. You definitely feel a lack of control and just a fear for your own well-being because, unfortunately, there are so many health care professionals … in the hospital who just don’t know enough about the ins and outs of insulin-dependent diabetes.”

Sadly, Amy’s experience isn’t unique. As the community focuses on raising awareness and bringing attention to diabetes this November, it’s important to highlight the challenges and opportunities for better inpatient diabetes care.

The State of Inpatient Glycemic Management

Managing blood glucose in the hospital is a challenge that impacts a large portion of our population as 34 million Americans live with diabetes and 84 million with prediabetes. On top of that, there are many other reasons a person (even someone not diagnosed with diabetes) can experience elevated blood sugar in the hospital. For example, stress hyperglycemia can occur because of surgery or other critical illness, like COVID-19.

Due to the scale of the problem, it’s very easy to find stories posted online where someone living with diabetes had to intervene and insist on overriding a doctor’s orders during a hospital stay. There are even message boards where people living with diabetes discuss checklists for hospital stays because they were prepared for the likelihood that providers may not be similarly prepared to support their needs appropriately.

What are the reasons behind these stories?

Diabetes is one of the chronic diseases where the patient is highly attuned and responsible for their own daily care. Typically, patients know their bodies, have years of experience with insulin pumps and Continuous Glucose Monitors (CGMs) and are deeply intimate with their dietary restrictions and personalized insulin regimens. Most hospitals are not equipped to provide the personalized level of care that's required.

Despite governing bodies like the American Diabetes Association recommending facilities use protocols that deliver more personalized care, many inpatient settings rely on dangerous, one-size-fits-all methods for managing glycemia. In fact, across the 6,000+ hospitals in the U.S., many clinicians still rely on time-intensive manual calculations or simple digitized calculators built into electronic medical records to aid insulin dosing decisions. These tools are simplistic, error-prone, incapable of delivering personalized treatment plans and are not the standard of care.1

Combine these practices with removing a patient's insulin pump or CGM technology, whether due to hospital policy or their physical inability to manage the equipment during a visit, and patients can experience severe negative outcomes. In fact, these methods are a big reason that insulin is involved in 16.3% of medication error reports for high-alert medications in acute care settings, more than any other medication type.

The bottom line is that many hospitals still do not have the right solutions to successfully and consistently manage patients’ blood glucose levels. At the end of the day, we need to make it easier for clinicians to solve this challenge and we must make the quality of care better for the patients.

Doing Better for Providers and Patients

A longtime advocate living with type 1 diabetes, Tenderich also shared her vision and hope for the future:

“It would be a dream to know that the clinic that you’re in actually has a software program or some kind of modern protocol that’s going to proactively keep you in range and also keep all of the staffers informed at the same time about your care. It would be so great to take that burden off, so you don’t have to just be concerned about your glucose and your diabetes all the time and can concentrate on the reason that you’re in the hospital in the first place.”

The good news is that Amy’s dream is a reality for patients at hospitals with best-in-class glycemic management solutions. Software as a medical device like Glytec’s Glucommander dosing modules can provide clinicians with personalized insulin dosing decision support at the point of care, workflow alerts for blood glucose checks, patient monitoring, at-risk patient identification, advanced analytics and more.

In fact, our solution is clinically proven to reduce the frequency of severe low blood sugar by 99.8%, cut the average length of stay by 3.2 days2, slash preventable hypoglycemia-related adverse drug events by 62.6%3 and has been shown to save roughly $3,000 per severe hypoglycemic event prevented2. Glytec’s eGMS and Glucommander help patients get into range faster4, stay within tighter parameters2 and experience fewer insulin-related adverse drug events3. And it makes it significantly easier for providers to deliver an elevated level of care because of safety guardrails, workflow guidance and the help of Glytec’s team of clinical experts who are available to advise on best practice.

While there are currently many challenges with inpatient glycemic management, there is also mounting momentum to address them. The Centers for Medicare & Medicaid Services (CMS) recently published new rules that highlight the importance of this problem. These measures introduce essential metrics that will help hospitals across the country focus on improving safety, outcomes and costs with better hyper- and hypoglycemia management.

The new measures are a significant step forward that will help hospitals standardize and benchmark levels of severe high and low blood sugar, improve transparency to patients by sharing the data publicly and hold them accountable for the results. To recognize Diabetes Awareness Month, it’s essential that we keep beating the drum and raising awareness around the critical need for health systems to modernize the way they manage patients’ blood sugar and insulin therapy in the inpatient setting. We need to make sure peace of mind becomes a staple for every patient experience.

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  1. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2020. American Diabetes Association. Diabetes Care Jan 2020, 43 (Supplement 1) S193-S202; DOI: 10.2337/dc20-S015
  2. Newsom R, Patty C, Camarena E, Gray T, Sawyer R, Brown B, McFarland R. Safely Converting From Sliding Scale to Basal Bolus Insulin Across an Entire Medical Center via Implementation of the eGlycemic Management System. American Diabetes Associa- tion Scientific Sessions. June 2017.
  3. Dudley D, Gaines M. Use of Technology Reduces Incidence of Hypoglycemia-Related Adverse Drug Events Among Patients Re- quiring Insulin Therapy While Hospitalized. DTS Virtual Poster Meeting. June 18, 2020.
  4. Comparative Effectiveness of a Computerized Algorithm Versus a Physician Instituted Protocol to Manage Insulin Infusions After Cardiac Surgery. Clinical Medicine & Research, Apr 2014.

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