Abordaje de la glucemia intrahospitalaria en el paciente no-crítico: impacto de la intervención proactiva en base a un sistema de point-of-care con visualización remota de glucemias capilares

Abstract

Background and objectiveThe management of hyperglycemia in conventional wards is suboptimal. The objective of our study was to evaluate the efficacy of a proactive intervention supported by point-of-care system with remote viewing of capillary blood glucose (CBG) on glycemic control as compared to usual care in non-critical surgical patients. Patients and methodTwo sequential periods of 2 months were defined. In the first phase (control, CPh), in which the surgical team was in charge of glycemic control, capillary glucose levels were recorded by StatStrip® system, and endocrinological support was provided upon surgeons request. In a second phase (intervention, IPh), the endocrinologist proceeded based on remotely-viewed CBG values. We compared the use of basal-bolus therapy and the degree of glycemic control between the 2 study periods. ResultsThe IPh was associated with greater use of basal-bolus regimens (21.4 vs. 58.3%; P=.003). The average CBG during the CPh was 161±64 vs. 142±48mg/dL during the IPh (P<.001). The IPh was associated with an increased frequency of CBG determinations between 70-140mg/dL (CPh: 41.8 vs. IPh: 52.5%; P<.001), lower frequency of≥250mg/dL CBG determinations (CPh: 9 vs. IPh: 3.5%; P<.001), with no increase in the frequency of hypoglycemia (CPh: 3 vs. IPh: 3.7%; P=.39). ConclusionsA proactive endocrine intervention facilitated by a point-of-care system with remote viewing of CBG is associated with improved glycemic control in non-critical patients, without any further increase in the number of hypoglycaemic recordings.