NOVEMBER 5, 2019
Survey Reveals Better Care Needed for Hospitalized Patients with Diabetes
Results of a nationwide survey indicate most hospitals do not employ best practices in glucose control, which leads to increased safety risks, higher readmission rates and significantly greater costs.
Waltham, MA — According to a recent survey, more than 75% of U.S. hospitals employ an outdated form of insulin therapy inconsistent with recommendations by the American Diabetes Association, American Association of Clinical Endocrinologists, Society of Hospital Medicine and other authoritative sources.
On average, one of every three hospitalized patients — the majority with diabetes — requires insulin to control blood glucose during their stay. Although widely prescribed and absolutely necessary, insulin is inherently dangerous: 50% of all medication errors involve insulin, including one-third of all fatal medication errors. Results of the survey indicate many of the processes and protocols fundamental to high-reliability care for patients with diabetes are absent or lacking in our nation’s hospitals.
Download the complete survey results here.
When best practices for insulin therapy are not the norm and variation is widespread, poorly controlled blood glucose prevails, which can lead to coma, stroke, sepsis, cardiac arrest . . . even death. A recent study by AdventHealth Orlando showed that hospitalized patients who experience severe hypoglycemia (abnormally low blood glucose) incur $10,405 of excess cost, a 61.5% higher readmission rate and a 6.6-day longer stay. With the shift from volume to value, diabetes care and glycemic management must become strategic imperatives.
Among a total of 619 survey respondents representing 408 U.S. hospitals:
- There is consensus that fear of hypoglycemia has a strong influence on the prescribing of insulin, i.e., causes non-prescribing or lack of intensification following hyperglycemia (a state of elevated blood glucose), which can readily compromise patients’ recovery and place them in a highly vulnerable state.
- In spite of abundant evidence demonstrating the limitations and harms of sliding scale insulin, less than a quarter maintain their hospital uses primarily basal bolus insulin. Opinions regarding the top two barriers to full adoption of basal bolus insulin are not related to financial, technical or operational constraints, but rather to knowledge and beliefs, specifically: (1) inadequate prescriber knowledge about basal-bolus-correction regimens, and (2) beliefs that sliding scale is acceptable practice and not harmful.
- Only 58 percent of those who work at a hospital with less than 400 beds have a multidisciplinary steering committee that oversees glycemic management and diabetes care. Some form of such a committee is integral to overcoming the issues surrounding fear of hypoglycemia, suboptimal insulin prescribing practices and barriers to full adoption of basal bolus insulin.
- Less than 50 percent are of the opinion glycemic control is ‘extremely important’ or ‘very important’ to senior clinical executives, and only 25 percent believe this to be true of non-clinical senior executives. Interestingly, when asked whether they believe senior leadership is aware of the safety risks and clinical consequences of hypoglycemia, the overwhelming majority, nearly 85 percent, said yes. The inference is that in spite of being aware of the gravity, senior executives simply do not prioritize glycemic control. As we know, little can be achieved without the buy-in and support of senior leadership.
The good news is, improving the care of hospitalized patients with diabetes and achieving best practices in glycemic management are attainable goals, especially with the aid of purpose-built technologies such as the eGlycemic Management System® from Glytec.
Healthcare professionals and leaders may arrange a complimentary consultation with a Glytec physician executive to discuss their glycemic goals, needs and challenges. Click here to schedule time at the upcoming Becker’s CEO + CFO Roundtable, IHI National Forum or by phone.
Founded in 2006, Glytec is the pioneer of digital therapeutics, improving lives of people with diabetes through insulin optimization technologies and services. The company’s patented eGlycemic Management System® is the only FDA-cleared software-as-a-medical-device (SaMD) platform purpose built to support best practices in insulin therapy across the continuum of care: inpatient, outpatient and virtual settings alike. Glytec offers several comprehensive programs combining evidence-based decision support technologies with expert professional services proven to reduce hyperglycemia, hypoglycemia, A1C, readmissions, length of stay and cost. The company has offices in Waltham, Massachusetts and Greenville, South Carolina. For more information visit www.glytecsystems.com.