Virtual System Works in Managing Diabetes for Hospital Patients

Note: CTSI provided support for this study.

An innovative virtual glucose management service (vGMS) for hospitalized patients with diabetes is highly effective at maintaining appropriate glucose levels, according to a study led by researchers at UC San Francisco.

The system, which was developed by UCSF diabetes specialists, combines an automated daily report of all patients experiencing high or low glucose levels, with individual reviews by a trained diabetes specialist via the electronic medical record (EMR). These are integrated into each patient’s record, along with a program that customizes ideal insulin levels based on whether the patient has eaten, or other factors. Together, these enable providers who are not diabetes specialists to immediately assess the correct amount of insulin to provide.

Their study appears online March 28, 2017, in Annals of Internal Medicine.

“With this new system, there has been a 39 percent decrease in patients on the daily high-glucose hospital report,” said lead author Robert Rushakoff, MD, MS, professor of medicine at UCSF and medical director for inpatient diabetes at UCSF Medical Center. “The vGMS and similar inpatient-services leveraging technology may also become economically important for cost savings, as medicine moves toward bundled care.”

Diabetes (hyperglycemia) causes blood glucose (sugar) levels to rise higher than normal. More than 29 million Americans, or about 9.3 percent of the population, are living with diabetes, and an estimated 86 million are living with prediabetes, a serious health condition that increases the risk of diabetes, according to the U.S. Centers for Disease Control and Prevention.

About a third of hospitalized patients have diabetes, which is associated with increased risks for complications, length of stay, costs of care and mortality. Blood glucose levels in inpatients often exceed recommended targets due to low priority given to glycemic control, suboptimal regimens chosen for simplicity over effectiveness and difficulty titrating insulin in acutely ill patients. Diabetes treatment also can cause hypoglycemia, or low blood sugar levels, which is linked to mortality, increased likelihood of readmission and longer hospital stays.

Diabetes specialists and inpatient diabetes teams performing formal consultations can reduce length of stay and improve glycemic control and clinical outcomes, but these are time and resource intensive.

vGMS Simplifies Diabetes Management Process

In the Annals of Internal Medicine study, Rushakoff and his colleagues analyzed 12,535 non-obstetric adult patients at three UCSF Medical Center hospitals who had two or more elevated or lowered glucose values in the previous 24 hours, as identified from a daily glucose report. The analysis occurred during three 12-month periods from June 2012 to May 2015: pre-vGMS (June 2012 to May 2013), transition (June 2013 to May 2014) and vGMS (June 2014 to May 2015).

Rather than rely on manual contact of clinical teams individually, the research team of diabetes specialists developed an electronic method to convey recommendations via a new glucose management note. The automated glucose reports, clinician review and clinical notes combined to create the vGMS.

The UCSF vGMS team consisted of three providers, all with several years of inpatient diabetes experience: a board-certified endocrinologist (MD), a nurse educator (DNP and certified diabetes educator) and a pharmacist diabetes educator (PharmD and certified diabetes educator).

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