PROMOTING GLUCOSE CONTROL IN MEDICAL SURGICAL PATIENTS WITH TYPE 2 DIABETES MELLITUS AT THE AMERICAN UNIVERSITY OF BEIRUT MEDICAL CENTER

Abstract

Background: Diabetes mellitus (DM) is a chronic metabolic disease characterized by elevated levels of blood glucose (BG). There are two types of DM: type 1 and type 2. About one in four patients with DM is hospitalized. Thus, inpatient BG control, assessment, and management are important aspects that require attention. Glucometrics is a set of measures that aims to evaluate the effectiveness of blood sugar control in the hospital setting. The BG level is obtained by point-of-care testing (POCT) via fingerstick and subsequently reflects transient changes in BG within the acceptable BG range. To facilitate advances in this nascent field, standardized metrics for inpatient glycemic control should be developed.

Aims: The study has two aims. One is to compare glucometrics at AUBMC before and after implementation of the adult subcutaneous insulin clinical order sets and the hypoglycemia management protocol, and the second aim is to compare glucometrics after the protocols’ implementation with the SHM benchmark values.

Design: A retrospective cohort study based on electronic medical record review. Glucometrics of patients with type 2 diabetes mellitus admitted to AUBMC 3 months prior to implementation were compared to those of patients admitted 3 months following implementation. Sample: The sample consisted of 228 adult inpatients, of whom 86 were admitted before and 142 after the new protocol was implemented; all patients were 18 or older and admitted to medical-surgical units.

Procedure: IRB approval was secured. Fingerstick POCT-BG results with their timestamp for patients with T2DM in addition to their demographic and clinical characteristics. The time frame was three months before (December 2020, January 2021, and February 2021) and three months after (May, June, and July 2021) the implementation of the new protocol. The data were extracted using the Electronic Privacy Information Center (EPIC) system.

Results: There was no difference in the descriptive variables between the two groups, pre- and post-protocol. The comparison of pre- and post-protocol data revealed significantly lower sample BG values, lower hyperglycemia, and severe hyperglycemia, with somewhat higher hypoglycemia in post protocol compared to pre-protocol data. The improvement in glucometrics was statistically significant mostly at the samples’ level of analysis. Significantly lower severe hyperglycemia (BG > 299 mg/dL) was found post-protocol at all levels of analysis (patient-samples, patient-stay, and patient-day). Moreover, the results that compare the post-protocol data at AUBMC to the benchmark were all within the range of the benchmark, except for the patient day with any BG > 180 mg/dL, which was 62.09% vs. 29.5% for the benchmark. And, also, higher than the upper limit of the benchmark's range of 12% to 45.8%, which shows that there is room for improvement for this protocol.

Conclusion: This project provided preliminary data to evaluate the effectiveness of the newly introduced protocols for glucose control. Other investigators still used different ways of analyzing the data. It is recommended to use multiple methods of analysis since no one method is considered superior. The findings show promise in terms of blood glucose control, but there is room for improvement, including more compliance with the guidelines and better documentation.