Remote monitoring may improve diabetes inpatient care
medwireNews: A study suggests that use of a virtual glucose management service (vGMS) can reduce hyper- and hypoglycemia among inpatients with diabetes by around a third.
The research involved three hospitals in San Francisco, in which ward staff measured patients’ glucose levels and uploaded them to the patients’ records. The system generated daily reports of patients who had one or more hypoglycemic measurements or two or more hyperglycemic measurements in the previous 24 hours, plus those who used insulin pumps.
Three clinicians experienced in diabetes reviewed these reports, without examining the patients, and entered any insulin recommendations into the system (all patients were managed with a basal–bolus insulin regimen), which could then be enacted by ward staff.
During the 1 year before and the first 2 years after the vGMS’s implementation, more than 19,000 inpatients underwent point-of-care glucose monitoring. The introduction of the service resulted in a 39% reduction in the proportion of patients with at least two hyperglycemic readings, from 6.6 per 100 patients per day before the service introduction to 5.4 and 4.0 per 100 patients per day in its first and second years, respectively.
The proportion of patients with hypoglycemia was already low, at 0.78 per 100 patients per day. This did not decrease during the first year after the vGMS implementation, but fell by 36%, to 0.49 per 100 patients per day, in the second year.
During the first year of the service, the overseeing clinicians made insulin recommendations for 3.9% of all glucose-monitored patients, rising to 4.8% during the second year, report Robert Rushakoff (University of California, San Francisco, USA) and study co-authors in the Annals of Internal Medicine.
In an accompanying editorial, Gerry Rayman (Ipswich Hospital NHS Trust, UK) says: “The current study is unique not only in the magnitude of change but also because the improvements were delivered by a system that is totally virtual, without the need for a ‘hands-on’ inpatient diabetes service.”
He notes that the inclusion of some form of bedside care could be expected to deliver even greater benefits, with experienced clinicians able to account for factors including lipohypertrophy, errors in carbohydrate counting, and poor injection technique by nurses or patients.
“If such care resulted in shorter stays or fewer readmissions, it could even be cost-saving,” he says.
However, Rayman observes that the system requires full adoption of electronic medical records and prescribing, which is not the case for many healthcare systems, and that remote management may not fit well into systems such as the UK’s, where patient involvement with disease management is becoming increasingly central to diabetes care.
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