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Study pinpoints variations in glycemic control across US hospitals
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ENDO 2011
BOSTON — Hyperglycemia is common in large US hospitals, but occurs less frequently in larger institutions, academic centers and hospitals in the Western states, a new study found.
Researchers reported the analysis of more than 49 million point-of-care blood glucose measurements.
“We looked at inpatient glycemic control for 575 hospitals, which is the largest study to date,” Christine Swanson, MD, from the Mayo Clinic Arizona in Scottsdale, told Endocrine Today. She said this is an update to previous data by Curtiss Cook, MD, and colleagues on 126 hospitals published in the Journal of Hospital Medicine in 2009.
Swanson said 32% of patient days in both the ICU and non-ICU had an average glucose level of 180 mg/dL or greater.
“Hospitals with the highest blood glucose values were the smaller hospitals with less than 200 beds, those in rural communities and those in the Northeast,” Swanson said in an interview. “This was true for both ICU and non-ICU settings.”
Hypoglycemia (defined as 70 mg/dL or lower) was less common among inpatients, occurring in approximately 6% of patient days in the ICU and non-ICU. ICU patients in hospitals of the Northeast had the fewest patient days with hypoglycemia, while hypoglycemic values were more common in larger hospitals and academic institutions.
These data were generated via an automated laboratory data management system maintained by the Epsilon Group (Charlottsville, VA) to extract results of point-of-care blood glucose tests conducted at the patient bedside. The information was compiled from participating hospitals in 2009. Of the 575 participating hospitals, 47% were small institutions with fewer than 200 beds; 71% were urban community hospitals; and 48% were located in the southern US.
“Inpatient hyperglycemia is a measure of interest to many quality improvement organizations because it is associated with increases in complications, hospital length of stay and mortality,” Swanson, internal medicine resident at Mayo Clinic Arizona, said in a press release. “Although control of glucose in the hospital has received widespread attention in recent years, little is known about glycemic control in a large number of hospitals across the country.”
However, the reasons for the differences found in this study are not clear because the researchers did not have patient-specific patient information, Swanson said. She noted another limitation of the study: the hospitals included are not statistically representative of the US population. – by Katie Kalvaitis
Disclosure: Dr. Swanson reports no relevant financial disclosures.
For more information:
- Swanson C. P2-749. Presented at: The Endocrine Society 93rd Annual Meeting & Expo; June 4-7, 2011; Boston.
This '35,000-foot view' of glycemic control in US hospitals is of significant interest to those of us involved in inpatient diabetes management programs. With one-third of patients maintained well outside what many would consider an optimal glycemic range, there remains plenty of room for quality improvement efforts. These efforts should be targeted at avoid both uncontrolled hyperglycemia, as well as hypoglycemic events. Our hospitalized patients with diabetes remain especially vulnerable to such abberations of metabolic control.
– Silvio E. Iznucchi, MD
Professor of Medicine, Yale University
Director, Yale Diabetes Center
Yale-New Haven Hospital
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