Roughly one third of patients experience hyperglycemia, or high blood sugar, during their hospital stay, and many of those patients don't have diabetes or are undiagnosed. Blood sugar levels tend to go higher when a patient is critically ill, for example, after heart surgery – a condition referred to as stress hyperglycemia. Stress hyperglycemia in seriously ill patients worsens outcomes – higher medical costs, higher incidence of infection and readmission to the hospital, and higher mortality rates.
Until recently there were no national standards of care for managing hyperglycemia in the inpatient setting. That changed with the 2005 release of the American Diabetes Association's (ADA) Clinical Practice Guidelines – the ADA's first guidelines relating to inpatient hyperglycemic care. By adopting and implementing these guidelines, the University of Kentucky HealthCare Chandler Medical Center is making huge strides in assuring that hyperglycemic patients don't fall through the cracks.
"The effects are immediate. This will help patients now," said Dr. Raymond Reynolds, co-chair of UK's Glycemic Control Task Force and UK College of Medicine Associate Professor of Internal Medicine, Division of Endocrinology and Molecular Medicine. "We are educating physicians, nurses, pharmacists, dietitians – the entire healthcare team. We're giving them the tools they need to better treat patients."
The traditional way of dealing with hyperglycemia in non-diabetic hospitalized patients: Simply not treating it or using sliding scale insulin treatment. In the sliding scale method, a patient is given an insulin injection only after his or her blood sugar level has spiked, without regard for meal schedules or the patient's sensitivity to insulin. This may cause dangerous highs and lows in the patient's blood sugar level. In other words, sliding scale insulin treatment is a method of correction, not control.
"Sliding scale insulin – those are dirty words to an endocrinologist," Reynolds said. "It is reactive rather than proactive. Sliding scale insulin treatment puts a patient on a blood sugar level roller coaster, and it's a dangerous ride."
Under the new guidelines, nurses and physicians will follow detailed protocols based on a patient's condition and blood glucose level. For example, blood glucose levels in critically ill patients will be kept as close to 110 mg/dl as possible, most likely with intravenous insulin. Other improvements in patient care include:
- So-called ADA Diets will be replaced with Consistent Carbohydrate diets, which help regulate blood sugar.
- A diabetes education plan will be developed for each patient.
- Follow-up testing will be planned for patients experiencing hyperglycemia while in the hospital but not diagnosed with diabetes.
"This is not an overnight change. It requires months of preparation and education," Reynolds said. "We'll follow outcomes and expect to see great improvements as a result of our hard work."
Nurses and other staff members will be attending in-service education sessions through April. An online learning module, designed by Dr. Reynolds, is available for physicians. In addition, staff across multiple units have been identified as "Champions" and will serve as experts on the topic.
The UK Chandler Medical Center will be providing its expertise to other hospitals in various ways. UK's Glycemic Control Program will likely be used as a model in hospitals across the state and beyond. For more information, or to make an appointment, contact the UK Division of Endocrinology and Molecular Medicine at 859-323-5575.
In striving to become a Top 20 public research institution, the University of Kentucky is a catalyst for a new Commonwealth – a Kentucky that is healthier, better educated, and positioned to compete in a global and changing economy. For more information about UK's efforts to become a Top 20 university, please go to http://www.uky.edu/OPBPA/Top20.html