Glucometrics: Assessing Quality in Inpatient Glycemic Management

Glucometrics: Assessing Quality in Inpatient Glycemic Management

Key Points

  • Glucometrics is a way to measure the success of inpatient glucose management. Getting timely and accurate metrics to frontline clinical teams, which can analyze the results and look for cause and effect, will transform performance improvement into optimal outcomes.

  • Glucometrics generally consists of 3 measures:

    • Glycemic exposure

    • Efficacy of control

    • Rate of adverse events

  • Basing performance metrics on blood glucose data will help to identify opportunities for improvement in glycemic management across the health system.

  • Determining which metrics to use depends on the outcome of interest, for example:

    • Proportion of low or extremely high blood glucose measures

    • Proportion of blood glucose measures within the target glucose range

  • Whatever set of metrics a hospital team chooses, getting data, validating its integrity, presenting it at the unit/facility/executive level, and assigning responsibility are key steps toward establishing a culture of performance improvement.

Suggested Reading

Glucometrics Resources

Society of Hospital Medicine. Glycemic Control Resource Room. Introducing glucometrics.

Thomas P. Glucometrics. Measuring inpatient glycemic control. New Haven, CT: Yale Center for Medical Informatics.

Clinical Guidelines

Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15:353-369.

Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97:16-38.

Additional Reading

Bergenstal RM, Anderson RL, Bina DM, et al. Impact of modem-transferred blood glucose data on clinician work efficiency and patient glycemic control. Diabetes Technol Ther. 2005;7:241-247.

Buchs AE, Rapoport MJ. Institutional glucometrics to determine glucose control as practiced by general medicine wards. Isr Med Assoc J. 2010;12:463-467.

Cook CB, Moghissi E, Joshi R, et al. Inpatient point-of-care bedside glucose testing: preliminary data on use of connectivity informatics to measure hospital glycemic control. Diabetes Technol Ther. 2007;9:493-500.

Cook CB, Wellik KE, Kongable GL, Shu J. Assessing inpatient glycemic control: what are the next steps? J Diabetes Sci Technol. 2012;6:421-427.

Dungan K, Chapman J, Braithwaite SS, Buse J. Glucose measurement: confounding issues in setting targets for inpatient management. Diabetes Care. 2007;30:403-409.

Goldberg PA, Bozzo JE, Thomas PG, et al. “Glucometrics”—assessing the quality of inpatient glucose management. Diabetes Technol Ther. 2006;8:560-569.

Goldberg PA, Siegel MD, Russell RR, et al. Experience with the continuous glucose monitoring system in a medical intensive care unit. Diabetes Technol Ther. 2004;6:339-347.

Goldstein DE, Little RR, Lorenz RA, et al. Tests of glycemia in diabetes. Diabetes Care. 2004;27:1761-1773.

Kosiborod M, Inzucchi SE, Krumholz HM, et al. Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation. 2008;117:1018-1027.

Lipton JA, Barendse RJ, Akkerhuis KM, Schinkel AF, Simoons ML. Evaluation of a clinical decision support system for glucose control: impact of protocol modifications on compliance and achievement of glycemic targets. Crit Pathw Cardiol. 2010;9:140-147.

Lipton JA, Barendse RJ, Schinkel AF, Akkerhuis KM, Simoons ML, Sijbrands EJ. Impact of an alerting clinical decision support system for glucose control on protocol compliance and glycemic control in the intensive cardiac care unit. Diabetes Technol Ther. 2011;13:343-349.

Morris AH, Orme J Jr, Truwit JD, et al. A replicable method for blood glucose control in critically ill patients. Crit Care Med. 2008;36:1787-1795.

Munoz M, Pronovost P, Dintzis J, et al. Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice. Jt Comm J Qual Patient Saf. 2012;38:195-206.

Oeyen SG, Hoste EA, Roosens CD, Decruyenaere JM, Blot SI. Adherence to and efficacy and safety of an insulin protocol in the critically ill: a prospective observational study. Am J Crit Care. 2007;16:599-608.

Peeples M, Rice D. Tools, technologies, and informatics: supporting glycemic control. Endocr Pract. 2006;12(suppl 3):100-107.

Rood E, Bosman RJ, van der Spoel JI, Taylor P, Zandstra DF. Use of a computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation. J Am Med Inform Assoc. 2005;12:172-180.

Shulman R, Finney SJ, O'Sullivan C, Glynne PA, Greene R. Tight glycaemic control: a prospective observational study of a computerised decision-supported intensive insulin therapy protocol. Crit Care. 2007;11:R75.