Inpatient glucose management programme in the Asian healthcare setting.

Abstract

To implement an inpatient glucose management (IGM) programme in the general medical wards and evaluate its clinical efficacy. Consecutive patients admitted to selected medical wards over a 12-month period were included in the IGM programme. All patients with ≥3 capillary blood glucose (CBG) readings (>10.0mmol/L and/or <4.0mmol/L) over a 24-hour period were identified electronically. A multidisciplinary team of diabetes care providers would provide specialist input to these patients. The control group comprised of consecutive patients admitted over the preceding 12months. Outcome glucose measures include mean in-hospital glucose (MHG), mean patient-day glucose (MDG), proportion of CBG readings at predefined cut-offs and length of stay (LOS). Both the MHG and MDG were significantly lower following intervention (10.0±2.4mmol/L vs 11.2±2.6mmol/L, P<.001; 10.0±2.3mmol/L vs 11.2±2.6mmol/L, P<.001, respectively). Prevalence of hyperglycaemic events, defined by CBG >10.0mmol/L, was significantly lower at 36.5% versus 51.6% (P<.001). Hypoglycaemic events of CBG <4.0mmol/L remained infrequent at <1.0% before and after IGM programme. A greater proportion of glucose readings was controlled within the target range of 4.0-10.0mmol/L (62.6% vs 47.6%, P<.001). With the IGM programme in place, more patients received scheduled CBG monitoring, and a significant shortening of mean LOS by 3.2days was observed (P=.02). The IGM programme was effective in improving inpatient glycaemic monitoring and control in the general medical wards, with a significant reduction in LOS observed. These demonstrated the programme's potential to enhance quality and efficiency of patient care.