Why demand is growing to enhance glycemic control with inpatients

Health systems have an urgent need to improve inpatient glycemic control through the accurate and timely analysis of inpatient glucose data — known as glucometrics — to inform their decision-making and guide transformative quality improvements in patient care. A summary of the state of glucometrics can be found in this recent publication.

An obvious reason is the continued increase in diabetes cases and the fact that inadequate glycemic management negatively affects patient outcomes, leading to longer patient stays and additional costs of $10,000 per stay or higher. But another motivating factor is that health systems are currently in the reporting period for new Centers for Medicare & Medicaid Services (CMS) quality reporting measures. These initiatives are focused on reducing preventable incidences of hyperglycemia and hypoglycemia.

The problem is most health systems are unable to undertake the necessary analysis of glucose data to both improve patient care and fully assess the new CMS glycemic measures. Unlike sepsis, heart failure or other diseases that CMS closely monitors, most hospitals don’t have access to the analytics to understand their current state of glycemic management.

However, that is changing, with efforts to standardize glycemic management metrics and procedures, and the availability of platforms that provide detailed analytics, reporting and visual dashboards to give hospitals full visibility into glycemic management.

Management program issues

Diabetes is proliferating at a frightening rate in the United States. According to the latest statistics from the Centers of Disease Control and Prevention, 37.3 million people – representing 11.3 percent of the U.S. population – have diabetes, including 8.5 million whose conditions are undiagnosed. In the hospital setting, almost 40 percent of patients have diabetes or hyperglycemia.

Even so, most hospitals aren’t able to perform the glucometrics patients require to avoid incidents of severe hyper- and hypoglycemia. Nearly 60 percent say they lack automated methods of collecting and analyzing blood glucose data, hindering efforts to improve insulin management. And about one-third of hospitals currently have no glycemic management metrics at all.

Part of the problem can be traced to a lack of standardized reporting methods. Health systems don’t have clear benchmarks to follow, nor do they have common performance indicators, practical definitions or methods of data analysis to follow. As a result, they have disparate data and limited visibility into the actual rates of hypo- and hyperglycemia. 

Organizations such as the Society of Hospital Medicine, the National Quality Foundation and the National Healthcare Safety Network have supported initiatives to develop a standardized reporting system while working to raise awareness of the importance of glycemic management. 

Standardization will enable hospitals to evaluate their internal processes and gauge them against results from outside organizations to measure improvements over time. But health systems still need to be able to make use of their latest glucometrics in a timely fashion to prioritize those metrics that will most contribute to quality improvement.

How analytics and metrics can help

The CMS reporting measures are two-pronged. One focuses on severe hyperglycemia (high blood sugar), defined as the percentage of hospital days after the first 24 hours with a blood glucose (BG) reading greater than 300 mg/dL. The second targets severe hypoglycemia (low blood sugar), defined as the percentage of patients having one BG reading lower than 40 mg/dL during their stay within 24 hours of receiving insulin or other antihyperglycemic agents. The reporting period began in January for health systems that opted into the electronic clinical quality measures (eCQMs), with the information due at the end of February 2024.

New platforms can provide advanced analytics and dashboards that put all relevant data about glycemic management in one place. They can display trends, performance against benchmarks and other factors, such as data broken down according to patient stays, patient days and response times to treatment. The enhanced visibility they provide enables cross-domain collaboration among doctors, nurses, executives and others, which can improve care.

While making use of all that data, it's also important to prioritize the most critical metrics, including: 

Measuring outcome metrics like hypoglycemia by patient day. Most hospitals measure the incidence of hypoglycemia according to the percentage of BG values collected, which can create a false sense of quality. A rate of 0.1 percent for severe hypoglycemia per 100,000 BG values may look good, but it translates to 100 cases. Measuring according to a patient-day metric is more challenging to calculate, but it is much more clinically relevant.

Measuring the timeliness of blood glucose checks. Process metrics are essential to measuring progress, and an important metric is the BG timeliness with IV insulin. Excellent timeliness rates when needing to check hourly BGs have been shown to improve glycemic outcomes.

A data-driven future

Effective glycemic management is critical to improving care for a large number of patients, but it has been somewhat underserved in terms of tools and procedures for improving care. New CMS reporting measures and the rising rate of diabetes, however, are making improved glycemic management outcomes a priority. Fortunately, the technology is available to provide glucometrics with clear visibility, advanced analysis and valuable metrics. Combined with the right people and processes, it can create revolutionary quality improvement in patient care.

Jordan Messler, MD, SFHM, FACP is the chief medical officer with Glytec. He trained in internal medicine at Emory University in Atlanta, and subsequently served as an academic hospitalist at Emory University for several years after residency.