Integration of Data to Establish a Standard Operating Procedure for the Diabetic Patient Undergoing Hyperbaric Oxygen Therapy.

Abstract

The purpose of this study was to describe occurrences of hypoglycemia in the diabetic population undergoing hyperbaric oxygen therapy (HBOT). We also examined 2 secondary aims: link industry standards for management of hypoglycemia in the general diabetic population to the HBOT environment; and integrate HBOT data into an electronic health record system, as patients transition across inpatient and outpatient services and settings. A retrospective, descriptive study. The study took place within a hyperbaric medicine department located in a 1393-bed acute care medical center, part of a large, multihospital system. The study sample comprised 100 diabetic patients who underwent HBOT between January 1 and May 31, 2015. Sixty-seven percent were male; the mean age of participants was 62 years (range 32-92 years). Admission status was nearly equal with 53% hospital inpatients and 47% ambulatory outpatients. Hospital protocol required all patients to have a minimal prehyperbaric blood glucose level (BGL) of 100 mg/dL. The incidence of hypoglycemia (defined as a BGL <100 mg/dL, 5.5 mmol/L) was 122 of 1175 treatments (10.4%). Additional analysis was based on records for 66 of the 122 incidences with evaluable data from electronic medical records. The mean BGL pre-HBOT was 177.86 mg/dL, 6.54 mmol/L (range 53-439 mg/dL, 2.94-24.36 mmol/L); the mean BGL after HBOT was 165.09 mg/dL, 9.16 mmol/L (range 56-414 mg/dL, 3.11-22.98 mmol/L). Analysis of these 66 occurrences revealed that 52 of 66 (79%) were managed with high-carbohydrate juices and snacks; 8 of 66 (12%) received oral glucagon; and 6 of 66 (9%) received glucagon and high-carbohydrate snack. We found that standard treatment protocols for hypoglycemia ranged from 70 to 100 mg/dL, 3.89 to 5.55 mmol/L, for the general population and 80 to 120 mg/dL, 4.44 to 6.66 mmol/L, for the general diabetic population. We also found that HBOT diabetic data were not fully integrated into the electronic health records across all settings. Hypoglycemia is prevalent during HBOT. We recommend a minimum pre-treatment serum glucose of 120 mg/dL, 6.7 mmol/L.