Research Symposium
Study of the incidence hyperglycemia and
hypoglycemia before and after introduction of
glycemic control protocol at Catholic Health
System hospitals.
Presenter: Marat Gitman, PGY3
Mentor: Howard Lippes, MD
6/9/11
Background
• Hospitalized patients are subjected to direct
complications of high BG levels.
• High BG levels cause indirect harm.
• There is evidence of importance of glycemic
control in recovery from many serious illnesses.
• Hyperglycemia is found to be associated with
increased length of hospitalization and healthcare
costs.
Irl B. Hirsch, MD, Insulin in the Hospital Setting, ISBN/0-9701451-8-7, Adelphi Inc, 2002
Background
• ADVANCE - 11,140 patients.
• ACCORD -10,251 patients- high risk CV patients.
• NICE-SUGAR trial - 6,104 adults admitted to ICU.
• 4T study.
R. Hollman, Addition of Biphasic, Parandial and Basal Insulin to oral therapy in type 2 DM., NEJM
Background
Currently fasting BG below 140 mg/dL and random
BG below 180 mg/dL are the targets for BG control
in non-critically-ill patients.
• In order to avoid hypoglycemia, reassessment of
insulin regiment is recommended if BG level is below
100 mg/dL and reassessment is warranted if BG
level is below 70 mg/dL.
• All the decisions need to include considerations
about clinical conditions leading to the event.
• Updated guidelines are being developed.
American Association of Clinical Endocrinologists And American Diabetes Association CONSENSUS
STATEMENT ON INPATIENT GLYCEMIC CONTROL. Endocrine Practice Vol 15 No. 4 May/June 2009
Background
ACE/ADA Inpatient Diabetes and Glycemic Control
Consensus Conference. 2006
•
Jack L. Leahy, MD. Insulin management of diabetic
patients on general medical and surgical floors.
(University of Vermont)
•
Mary Korytkowski, MD. Evolution of a diabetes
inpatient committee. (University of Pittsburgh)
Based on this research, glycemic control protocol was
developed and implemented at CHS hospitals
Background
• Basal-bolus approach - 0.5 U/kg basal insulin.
• 0.1 U/kg rapid analog with meals for average pt.
• Dose of basal is lowered by 0.2 U/kg for medical
conditions with a high sensitivity to insulin or that
have an added risk for hypoglycemia.
• Renal or hepatic impairment, thin or normal weight,
elderly, frail, hypothyroidism, adrenal insufficiency,…
• Extra 0.2 U/kg basal is given for states of presumed
high insulin resistance.
• Marked obesity with metabolic syndrome, open
wounds, infections, …
Jack L. Leahy, MD. Insulin management of diabetic patients on general medical and surgical floors.
Glycemic Control Protocol at CHS
The initial rollout of the glycemic protocols was in
October 2008.
Phase 2 Rollout was in May 2009.
Phase 3 Rollout was in November 2010
Phase 4 education began in April of 2011 with a pilot
at SOCH.
RALS-TGCM
RALS-TGCM system was implemented at CHS
hospitals in prior years was used in current project .
• POC glucometers linked wirelessly to a database.
•
Advantages: reliable, unbiased data collection (no
human decision involved in sampling), ease-ofaccess, tools available for ad-hock trend analysis.
•
Disadvantages: Although basic analysis is readily
available, advanced analysis is rather limited,
limited data presentation parameters causing
possibility for ascertainment bias and
standardization problems.
Sample RALS output for one month of critical values
Methods
This study is retrospective database review.
CHS patients with Point-of-Care blood glucose
measurements.
Admitted to Medical-Surgical floors.
During May of 2006 through February of 2011 (57
months).
Compares monthly averages during 29 months
before the introduction of protocol to monthly
averages during 28 months post introduction.
Methods
During this time period, following data was reviewed.
426,563 BGTs at SOCH
840,787 BGTs at SBMH
240,849 BGTs at SJ
281,622 BGTs at KMH
Total of 1,789,821 BGTs reviewed.
No individual patient information was collected.
Data Analysis
Data was analyzed in multiple categories.
•
Critical Hypoglycemia (BG < 40) - % of total # BGTs
•
Critical l Hypoglycemia (BG < 40) - Mean Values.
•
Pre- & postmeal Hypoglycemia - % of total # BGTs
•
Pre- & postmeal Hypoglycemia -Mean Values.
•
Pre- & postmeal Hyperglycemia - % of total # BGTs
•
Pre- & postmeal Hyperglycemia - Mean Values.
SPSS software was used to find two tailed t-test for
independent (unmatched) samples.
11-Jan
10-Sep
SJ <= 39
10-Jan
0.009
0.008
0.007
0.006
0.005
0.004
0.003
0.002
0.001
0.000
10-May
SJ Critical Lows %
9-Sep
0.000
9-May
0.001
9-Jan
0.002
8-Sep
SOCH <= 39
8-Jan
0.004
8-May
0.005
7-Sep
SOCH Critical Lows %
7-May
0.006
7-Jan
0.003
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
0.007
6-Sep
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
0.008
6-May
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
Hypoglycemia Critical Values-Percent
SBMH Critical Lows %
0.010
0.009
0.008
0.007
0.006
0.005
0.004
0.003
0.002
0.001
0.000
SBMH <= 39
KMH Critical Lows %
0.007
0.006
0.005
0.004
0.003
0.002
KMH <= 39
0.001
0.000
Hypoglycemia Critical Values-Percent
SOCH_Below39_Percent
SBMH_Below39_Percent
SJ_Below39_Percent
KMH_Below39_Percent
Group
N
Mean
SD
SE Mean
P-Value
pre
29
0.0042
0.0011
0.0002
0.017
post
28
0.0033
0.0016
0.0003
pre
29
0.0048
0.0015
0.0003
post
28
0.0032
0.0009
0.0002
pre
29
0.0037
0.0018
0.0003
post
28
0.0025
0.0013
0.0002
pre
29
0.0033
0.0014
0.0003
post
28
0.0024
0.0011
0.0002
< 0.001
0.003
0.016
15
15
10
5
0
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
SOCH Critical Lows (Mean)
40
40
35
35
30
30
25
25
20
20
SOCH <= 39
10
10
5
5
0
0
SJ Critical Lows (Mean)
40
35
30
25
20
SJ <= 39
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
Hypoglycemia Critical Values-Means
SBMH Critical Lows (Mean)
15
SBMH <= 39
KMH Critical Lows (Mean)
45
40
35
30
25
20
15
10
5
0
KMH <= 39
Hypoglycemia Critical Values-Mean
SOCH_Below39_Mean
SBMH_Below39_Mean
SJ_Below39_Mean
KMH_Below39_Mean
Group
N
Mean
SD
SE Mean
P-Value
pre
29
30.8159
2.1017
0.3903
0.580
post
28
30.4864
2.3543
0.4449
pre
29
30.7724
0.9132
0.1696
post
28
30.6368
1.5105
0.2855
pre
29
31.1910
2.0801
0.3863
post
28
29.6596
2.8887
0.5459
pre
29
29.7921
2.2884
0.4249
post
28
30.9871
2.6485
0.5005
0.685
0.026
0.074
11-Jan
10-Sep
10-May
10-Jan
SJ <= 69
9-Sep
0.045
0.040
0.035
0.030
0.025
0.020
0.015
0.010
0.005
0.000
9-May
SJ Hypo (%)-Postmeal
9-Jan
0.000
8-Sep
0.010
8-May
SOCH <= 69
8-Jan
0.030
7-Sep
0.040
7-May
SOCH Hypo (%)-Postmeal
7-Jan
0.050
6-Sep
0.020
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
0.060
6-May
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
Postmeal Hypoglycemia-Percent
SBMH Hypo (%)-Postmeal
0.045
0.040
0.035
0.030
0.025
0.020
0.015
0.010
0.005
0.000
SBMH <= 69
KMH Hypo (%)-Postmeal
0.045
0.040
0.035
0.030
0.025
0.020
0.015
0.010
0.005
0.000
KMH <= 69
Postmeal Hypoglycemia - Percent
Group
N
Mean
SD
SE Mean
SOCH_PostMeal_Below_69 pre
_Percent
post
29
0.0328
0.0056
0.0010
28
0.0279
0.0084
0.0016
SBMH_PostMeal_Below_69 pre
_Percent
post
29
0.0332
0.0043
0.0008
28
0.0234
0.0033
0.0006
SJ_PostMeal_Below_69
_Percent
pre
29
0.0266
0.0065
0.0012
post
28
0.0199
0.0049
0.0009
KMH_PostMeal_Below_69
_Percent
pre
29
0.0246
0.0056
0.0010
post
28
0.0201
0.0052
0.0010
P-Value
0.013
<0.001
<0.001
0.003
59
58
57
56
55
54
53
52
51
50
49
30
20
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
SOCH Hypo (Mean)-Postmeal
SOCH <= 69
SJ Hypo (Mean)-Postmeal
70
60
60
58
50
40
SJ <= 69
10
50
0
48
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
Postmeal-Hypoglyecemia-Mean
SBMH Hypo (Mean)-Postmeal
58
57
56
55
54
53
52
51
50
49
SBMH <= 69
KMH Hypo (Mean)-Postmeal
56
54
52
KMH <= 69
Postmeal-Hypoglyecemia-Mean
group
N
Mean
SD
SE Mean
P-Value
SOCH_PostMeal
_Below_69_Mean
pre
post
29
28
54.5876
55.1496
0.9527
1.1566
0.1769
0.2186
0.051
SBMH_PostMeal
_Below_69_Mean
pre
post
29
28
54.3472
54.8304
1.0436
1.1116
0.1938
0.2101
0.097
SJ_PostMeal
_Below_69_Mean
pre
post
29
28
54.5090
54.9950
2.0987
2.0941
0.3897
0.3957
0.385
KMH_PostMeal
_Below_69_Mean
pre
post
29
28
54.6324
55.7504
1.5301
1.3474
0.2841
0.2546
0.005
0.010
0.010
0.000
0.000
SJ Premeal Hypo %
0.060
0.070
0.050
0.060
0.040
0.030
0.020
SJ <= 79
0.010
0.010
0.000
0.000
11-Jan
0.020
10-Sep
0.020
10-May
SOCH <= 79
10-Jan
0.040
9-Sep
0.040
9-May
0.050
9-Jan
0.050
8-Sep
0.060
8-May
0.060
8-Jan
0.070
7-Sep
0.070
7-May
SOCH Premeal Hypo %
7-Jan
0.080
6-Sep
0.030
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
0.080
6-May
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
Premeal Hypoglycemia-Percent
SBMH Premeal Hypo %
0.030
SBMH <= 79
KMH Premeal Hypo %
0.050
0.040
0.030
0.020
KMH <= 79
Premeal Hypoglyecemia-Percent
group
SOCH_PreMeal
pre
_Below_79_Percent post
N
29
28
Mean
0.0534
0.0463
SD
0.0080
0.0121
SE Mean
0.0015
0.0023
P-Value
0.013
SBMH_PreMeal
pre
_Below_79_Percent post
29
28
0.0551
0.0404
0.0060
0.0046
0.0011
0.0009
<0.001
SJ_PreMeal
pre
_Below_79_Percent post
29
28
0.0423
0.0331
0.0079
0.0066
0.0015
0.0012
<0.001
KMH_PreMeal
pre
_Below_79_Percent post
29
28
0.0414
0.0350
0.0079
0.0082
0.0015
0.0016
0.004
67
66
65
64
63
62
61
60
59
58
57
56
58
56
54
52
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
SOCH-Premeal-Hypo-Mean
SOCH <= 79
SJ-Premeal-Hypo-Mean
68
66
64
62
60
SJ <= 79
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
6-May
6-Aug
6-Nov
7-Feb
7-May
7-Aug
7-Nov
8-Feb
8-May
8-Aug
8-Nov
9-Feb
9-May
9-Aug
9-Nov
10-Feb
10-May
10-Aug
10-Nov
11-Feb
Premeal Hypoglycemia - Mean
SBMH-Premeal-Hypo-Mean
66
65
64
63
62
61
SBMH <= 79
60
59
58
KMH-Premeal-Hypo-Mean
67
66
65
64
63
62
61
60
59
58
57
KMH <= 79
Premeal Hypoglycemia - Mean
N
29
Mean
62.4017
SD
SE Mean
0.1949
1.0493
post
28
63.1436
1.2853
0.2429
SBMH_PreMeal
_Below_79_Mean
pre
post
29
28
62.5352
63.2525
0.8381
0.9839
0.1556
0.1859
0.005
SJ_PreMeal
_Below_79_Mean
pre
post
29
28
62.2197
62.9118
2.1032
2.0707
0.3906
0.3913
0.216
KMH_PreMeal
_Below_79_Mean
pre
29
62.9769
1.3766
0.2556
0.009
post
28
63.9618
1.3866
0.2621
SOCH_PreMeal
_Below_79_Mean
Group
pre
P-Value
0.021
SBMH_PostMeal_181_230
_Percent
SBMH_PostMeal_231_300
_Percent
SBMH_PostMeal_Above_301
_Percent
SJ_PostMeal_181_230
_Percent
SJ_PostMeal_231_300
_Percent
SJ_PostMeal_Above_301
_Percent
KMH_PostMeal_181_230
_Percent
KMH_PostMeal_231_300
_Percent
KMH_PostMeal_Above_301
_Percent
0.1702
0.1692
0.1183
0.1151
0.0821
0.0838
0.1468
0.1651
0.0838
0.1069
0.0446
0.0645
0.1901
0.1992
0.1358
0.1482
0.0875
0.0998
0.1720
0.1679
0.1178
0.1119
0.0841
0.0681
SOCH Hyper (%)-Postmeal
0.689
0.200
0.150
0.100
0.050
0.000
0.201
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
P-Value
0.546
<0.001
0.250
0.200
0.150
0.100
0.050
0.000
<0.001
<0.001
SJ Hyper (%)-Postmeal
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
SOCH_PostMeal_Above_301
_Percent
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
Mean
0.026
0.200
0.150
0.100
0.050
0.000
0.002
0.004
SBMH Hyper (%)-Postmeal
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
SOCH_PostMeal_231_300
_Percent
N
0.270
0.095
<0.001
181-230
231-300
> 301
0.250
0.200
0.150
0.100
0.050
0.000
KMH Hyper (%)-Postmeal
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
SOCH_PostMeal_181_230
_Percent
Group
SOCH - Hyper-(Mean) Postmeal
P-Value
390
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
203.1603
202.9543
260.5900
260.3157
372.0231
374.6471
202.3269
202.9314
259.2638
259.9486
366.0331
368.3818
203.4759
203.5961
260.5597
260.7350
368.3514
369.6021
202.9483
202.6629
260.5945
259.9736
372.0886
366.5211
0.139
340
290
240
0.161
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
190
0.055
SBMH - Hyper- (Mean) Postmeal
390
340
290
240
190
<0.001
0.001
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
pre
post
SOCH_PostMeal_231_300 pre
_Mean
post
SOCH_PostMeal_Above_301 pre
_Mean
post
SBMH_PostMeal_181_230 pre
_Mean
post
SBMH_PostMeal_231_300 pre
_Mean
post
SBMH_PostMeal_Above_301 pre
_Mean
post
SJ_PostMeal_181_230
pre
_Mean
post
SJ_PostMeal_231_300
pre
_Mean
post
SJ_PostMeal_Above_301
pre
_Mean
post
KMH_PostMeal_181_230
pre
_Mean
post
KMH_PostMeal_231_300
pre
_Mean
post
KMH_PostMeal_Above_301 pre
_Mean
post
Mean
0.036
SJ - Hyper- (Mean) Postmeal
390
340
290
240
190
0.510
0.519
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
SOCH_PostMeal_181_230
_Mean
N
0.405
KMH - Hyper- (Mean) Postmeal
0.064
390
340
0.012
290
240
0.004
181-230
231-300
> 301
190
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
Group
SOCH Premeal Hyper (%)
SBMH_PreMeal_131_150
_Percent
SBMH_PreMeal_151_180
_Percent
SBMH_PreMeal_Above_181
_Percent
SJ_PreMeal_131_150
_Percent
SJ_PreMeal_151_180
_Percent
SJ_PreMeal_Above_181
_Percent
KMH_PreMeal_131_150
_Percent
KMH_PreMeal_151_180
_Percent
KMH_PreMeal_Above_181
_Percent
P-Value
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
pre
post
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
0.1264
0.1310
0.1550
0.1611
0.3706
0.3680
0.1502
0.1434
0.1628
0.1632
0.2750
0.3361
0.1282
0.1237
0.1670
0.1619
0.4134
0.4470
0.1359
0.1446
0.1629
0.1674
0.3738
0.3478
0.034
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
0.023
0.676
0.400
<0.001
SBMH Premeal Hyper (%)
0.300
0.200
0.841
0.100
0.000
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
SOCH_PreMeal_Above_181
_Percent
Mean
<0.001
0.095
0.600
0.500
0.400
0.300
0.200
0.100
0.000
0.085
<0.001
0.006
0.113
0.004
SJ Premeal Hyper (%)
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
SOCH_PreMeal_151_180
_Percent
N
181-230
231-300
> 301
0.500
0.400
0.300
0.200
0.100
0.000
KMH Premeal Hyper (%)
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
SOCH_PreMeal_131_150
_Percent
Group
0.500
0.400
0.300
0.200
0.100
0.000
ud
N
Mean
P-Value
pre
post
pre
SOCH_PreMeal_151_180
_Mean
post
SOCH_PreMeal_Above_181 pre
_Mean
post
pre
SBMH_PreMeal_131_150
_Mean
post
pre
SBMH_PreMeal_151_180
_Mean
post
SBMH_PreMeal_Above_181 pre
_Mean
post
pre
SJ_PreMeal_131_150
_Mean
post
pre
SJ_PreMeal_151_180
_Mean
post
pre
SJ_PreMeal_Above_181
_Mean
post
pre
KMH_PreMeal_131_150
_Mean
post
pre
KMH_PreMeal_151_180
_Mean
post
KMH_PreMeal_Above_181 pre
_Mean
post
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
29
28
140.3345
140.3293
164.7983
164.6443
258.0503
258.7389
140.0714
140.1757
164.4186
164.5729
245.4752
252.0386
140.3738
140.4454
164.9714
164.9607
256.2062
258.8514
140.2886
140.1893
164.5734
164.6321
258.3093
252.4832
0.899
0.075
SOCH Premeal Hyper (Mean)
270
220
170
120
0.477
270
SBMH Premeal Hyper (Mean)
0.005
220
0.007
170
120
0.324
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
<0.001
SJ Premeal Hyper (Mean)
320
270
0.886
220
170
120
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
0.058
0.18
0.569
<0.001
KMH Premeal Hyper (Mean)
320
270
220
170
120
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
SOCH_PreMeal_131_150
_Mean
320
6-May
6-Sep
7-Jan
7-May
7-Sep
8-Jan
8-May
8-Sep
9-Jan
9-May
9-Sep
10-Jan
10-May
10-Sep
11-Jan
Group
Conclusions
The adoption of glycemic control protocols for noncritically-ill patients resulted:
• Statistically significant reduction in the
incidence of critical hypoglycemia.
• This change is consistent in all 4 hospitals.
• Mixed trend in mean BG during critical
hypoglycemic episodes.
• Statistically significant worsening at SJ, but mixed
non-statistically significant trend at SOCH, SBMH,
and KMH
Conclusions
• Statistically significant reduction in the incidence
of post-meal and pre-meal hypoglycemia.
• This change is consistent in all 4 hospitals.
• Trend towards improvement in mean BG during
post-meal hypoglycemic episodes.
• Statistically significant only achieved at KMH with
SOCH being borderline at (0.05)
• Statistically significant improvement in mean BG
during pre-meal hypoglycemic episodes.
• This change is consistent at 3 out of 4 hospitals with 4th
hospital showing trend toward improvement.
Conclusions
• Mixed trend in the incidence and mean BG of
pre-meal and post-meal hyperglycemia.
• Inconsistent between the hospitals and in statistical
significance.
Closing Remarks
• Back to 4T study
•
CHS hospitals mostly trend to use of basal
coverage with omission of bolus coverage. With
KMH and SOCH showing trend toward the
optimization of these modalities .
• How can this study be improved:
•
Chart review to identify site and time specific trends
in protocol use can give better insight when aligned
with findings of this study.
Acknowledgements
Dr. Howard Lippes
Sharon Wicks
Amanda Weber
IRB staff and committee
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