Abstract
Purpose of Review
Inpatient glucose data analysis, or glucometrics, has developed alongside the growing emphasis on glycemic control in the hospital. Shortcomings in the initial capabilities for glucometrics have pushed advancements in defining meaningful units of measurement and methods for capturing glucose data. This review addresses the growth in glucometrics and ends with its promising new state.
Recent Findings
Standardization, allowing for benchmarking and purposeful comparison, has been a goal of the field. The National Quality Foundation glycemic measures and recently enacted Center for Medicare and Medicaid Services (CMS) electronic quality measures for hypo- and hyperglycemia have allowed for improved integration and consistency.
Summary
Prior systems have culminated in an upcoming measure from the Center for Disease Control and Prevention’s National Healthcare Safety Network. It is poised to create a new gold standard for glucometrics by expanding and refining the CMS metrics, which should empower both local improvement and benchmarking as the program matures.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Lansang CM, Umpierrez GE. Inpatient hyperglycemia management: a practical review for primary medical and surgical teams. Cleve Clin J Med. 2016;83:S34–43. https://doi.org/10.3949/ccjm.83.s1.06.
Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, Rogers SO. Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg. 2008;248:585–91. https://doi.org/10.1097/SLA.0b013e31818990d1.
Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, Inzucchi SE, Ismail-Beigi F, Kirkman MS, Umpierrez GE. American Association of Clinical Endocrinologist and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32:1119–31. https://doi.org/10.2337/dc09-9029.
American Diabetes Association Professional Practice Committee; American Diabetes Association Professional Practice Committee: Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, Green J, Huang E, Isaacs D, Kahan S, Leon J, Lyons SK, Peters AL, Prahalad P, Reusch JEB, Young-Hyman D, Das S, Kosiborod M. 16. Diabetes care in the hospital: standards of medical care in diabetes-2022. Diabetes Care. 2022 Jan 1;45(Suppl 1):S244-S253. https://doi.org/10.2337/dc22-S016.
Goldberg PA, Bozzo JE, Thomas PG, Mesmer MM, Sakharova OV, Radford MJ, Inzucchi SE. “Glucometrics”–assessing the quality of inpatient glucose management. Diabetes Technol Ther. 2006;8(5):560–9. https://doi.org/10.1089/dia.2006.8.560.
Thompson BM, Cook CB. Glucometrics and insulinometrics. Curr Diab Rep. 2017;17(12):121. https://doi.org/10.1007/s11892-017-0964-2.
Schnipper JL, Magee M, Larsen K, Inzucchi SE, Maynard G. Society of Hospital Medicine Glycemic Control Task Force Society of Hospital Medicine Glycemic Control Task Force summary: practical recommendations for assessing the impact of glycemic control efforts. J Hosp Med. 2008;3(5 Suppl):66–75. https://doi.org/10.1002/jhm.356.
Maynard G, Schnipper JL, Messler J, Ramos P, Kulasa K, Nolan A, Rogers K. Design and implementation of a web-based reporting and benchmarking center for inpatient glucometrics. J Diabetes Sci Technol. 2014;8(4):630–40. https://doi.org/10.1177/1932296814532237.
Mathes T, Pieper D, Morche J, Polus S, Jaschinski T, Eikermann M. Pay for performance for hospitals. Cochrane Database Syst Rev. 2019;7(7):CD011156. https://doi.org/10.1002/14651858.CD011156.pub2.
Cook CB, Wellik KE, Kongable GL, Shu J. Assessing inpatient glycemic control: what are the next steps? J Diabetes Sci Technol. 2012;6(2):421–7. https://doi.org/10.1177/193229681200600230.
Maynard G, Berg K, Kulasa K, O’Malley C, Rogers KM. The glycemic control implementation guide: improving glycemic control, preventing hypoglycemia and optimizing care of the inpatient with hyperglycemia and diabetes (2nd ed.). Society of Hospital Medicine. 2015. https://www.hospitalmedicine.org/globalassets/clinical-topics/clinical-pdf/gcmi-guide-m4.pdf. Accessed 26 Sep 2022
Korytkowski MT, Muniyappa R, Antinori-Lent K, Donihi AC, Drincic AT, Hirsch IB, Luger A, McDonnell ME, Murad MH, Nielsen C, Pegg C, Rushakoff RJ, Santesso N, Umpierrez GE. Management of hyperglycemia in hospitalized adult patients in non-critical care settings: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2022;107(8):2101–28. https://doi.org/10.1210/clinem/dgac278.
Branch-Elliman W, Elwy AR, Lamkin RL, Shin M, Engle RL, Colborn K, Rove J, Pendergast J, Hederstedt K, Hawn M, Mull HJ. Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol. Implement Sci Commun. 2022;3(1):47. https://doi.org/10.1186/s43058-022-00288-0.
LaPar DJ, Isbell JM, Kern JA, Ailawadi G, Kron IL. Surgical Care Improvement Project measure for postoperative glucose control should not be used as a measure of quality after cardiac surgery. J Thorac Cardiovasc Surg. 2014;147(3):1041–8. https://doi.org/10.1016/j.jtcvs.2013.11.028.
Measures inventory tool. Centers for Medicare & Medicaid Services. http://cmit.cms.gov/cmit/#/. Accessed 30 Sep 2022.
Santos CAQ, Conover C, Shehab N, Geller AI, Guerra YS, et al. Electronic measurement of a clinical quality measure for inpatient hypoglycemia events: a multicenter validation study. Med Care. 2020;58(10):927–33. https://doi.org/10.1097/MLR.0000000000001398. The study assessed the National Quality Forum glycemic criteria and validated the ability to identify inpatient hypoglycemia using electronic queries. This development paved the way the subsequent Center for Medicare and Medicaid Services electronic measures.
Electronic clinical quality improvement resource center. Centers for Medicare & Medicaid Services. https://ecqi.healthit.gov. Accessed 26 Sep 2022
Hospital compare. Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare. Accessed 30 Sep 2022
Pakyz AL, Orndahl CM, Johns A, Harless DW, Morgan DJ, Bearman G, Hohmann SF, Stevens MP. Impact of the centers for Medicare and Medicaid services sepsis core measure on antibiotic use. Clin Infect Dis. 2021;72(4):556–65. https://doi.org/10.1093/cid/ciaa456.
Desai NR, Ross JS, Kwon JY, Herrin J, Dharmarajan K, Bernheim SM, Krumholz HM, Horwitz LI. Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions. JAMA. 2016;316(24):2647–56. https://doi.org/10.1001/jama.2016.18533.
NHSN Reporting: Adverse Drug Events – Glycemic Control 0.1.0 – CI Build. HL7 International – Public Health 2022 Jan 10. http://build.fhir.org/ig/HL7/fhir-nhsn-ade-ig/ The National Healthcare Safety Network is introducing hypoglycemia and hyperglycemia modules to address medication safety, patient safety, and quality improvement in inpatient glucose management.
Krinsley JS, Preiser JC, Hirsch IB. Safety and efficacy of personalized glycemic control in critically ill patients: a 2-year before and after interventional trial. Endocr Pract. 2017;23(3):318–30. https://doi.org/10.4158/EP161532.OR. Outcomes in patients based on glycosylated hemoglobin and varying glycemic goal ranges in the hospital were analyzed. This study points to future development in more personalized glucose targets.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing Interests
Jordan Messler is a paid employee of Glytec, Chief Medical Officer. Gregory A Maynard acts as a subject matter expert for SHM and NHSN Glucometrics. The other authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Engle, K., Bacani, G., Cook, C.B. et al. Glucometrics: Where Are We Now?. Curr Diab Rep 23, 127–134 (2023). https://doi.org/10.1007/s11892-023-01507-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11892-023-01507-1