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A Comparison of Inpatient Glucose Management Guidelines: Implications for Patient Safety and Quality

  • Nestoras Mathioudakis
  • Sherita Hill GoldenEmail author
Hospital Management of Diabetes (GE Umpierrez, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hospital Management of Diabetes

Abstract

Inpatient glucose management guidelines and consensus statements play an important role in helping to keep hospitalized patients with diabetes and hyperglycemia safe and in optimizing the quality of their glycemic control. In this review article, we compare and contrast seven prominent US guidelines on recommended glycemic outcome measures and processes of care, with the goal of highlighting how variation among them might influence patient safety and quality. The outcome measures of interest include definitions of glucose abnormalities and glycemic targets. The relevant process measures include detection and documentation of diabetes/hyperglycemia, methods of and indications for insulin therapy, management of non-insulin agents, blood glucose monitoring, management of special situations (e.g., parenteral/enteral nutrition, glucocorticoids, surgery, insulin pumps), and appropriate transitions of care. In addition, we address elements of quality improvement, such as glycemic control program infrastructure, glucometrics, insulin safety, and professional education. While most of these guidelines align with respect to outcome measures such as glycemic targets, there is significant heterogeneity among process measures, which we propose might introduce variation or even confusion in clinical practice and possibly affect quality of care. Guideline-related factors, such as rigor of development, clarity, and presentation, may also affect provider trust in and adherence to guidelines. There is a need for high-quality research to address knowledge gaps in optimal glucose management practice approaches in the hospital setting.

Keywords

Diabetes mellitus Hyperglycemia Hospitalized Inpatient Glucose management program Quality improvement 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Nestoras Mathioudakis and Sherita Hill Golden declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Nestoras Mathioudakis
    • 1
  • Sherita Hill Golden
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Division of Endocrinology, Diabetes, and MetabolismJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Armstrong Institute for Patient Safety and QualityJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA

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