INTRODUCTION
The prevalence of hyperglycemia in hospitalized patients is common and
in our study varied from 12% to 50% of all inpatients at our
facility1,2 1-3. Episodes of
hyperglycemia were associated with several reasons, to include: history
of diabetes mellitus (DM), newly diagnosed diabetes mellitus and
stress-related hyperglycemia 4,5. Inpatient
hyperglycemia has been associated with various adverse outcomes to
include a higher mortality, longer hospital stay, increased infections,
and complications 5,6. In clinic practice, the
achievement of blood glucose goal in inpatients with hyperglycemia is
not satisfied and a number of barriers can prevent the
achievement7,8. The physician’s omissions of
hyperglycemia and impaired medication timing due to hospital system are
important reasons that impact the management of hospitalized
patients7,8. While there have been numerous
publications on how to improve the management of glucose excursions in
hospitalized patients, available systems to date appear to have fallen
short of achieving optimal results 9-13. Although
diabetes management guidelines for inpatient diabetes advise the
development and use of inpatient blood glucose monitoring systems, no
gold standard models or systems presently exist.
We established a hospital-wide inpatient glucose management model for
glucose monitoring and response to clinically relevant glucose
excursions including: a glycemic care team (GCT), standard operation
procedures (SOP), and glucose care information system (GCI). The GCI was
integrated with our electronic medical record (EMR), and was developed
to provide an alarm message whenever noting hyperglycemia
(>7.8 mmol/L) or hypoglycemia (< 3 mmol/L) in a
patient. This system was named the Hospital-wide Mobile Phone Alert
(HMA) with it being developed to achieve real time warnings and
resultant timely response for glucose excursions with the intent of
improving overall glucose control. The study aimed to evaluate the
impact of the system HMA on inpatient hyperglycemia control.