Shu, Jianfen

Despite the emergence of glucometrics (i.e., systematic analysis of data on blood glucose levels of inpatients) as a subject of high interest, there remains a lack of standardization on how glucose parameters are measured and reported. This dilemma must be resolved before a national benchmarking process can be developed that will allow institutions to track and compare inpatient glucose control performance against established guidelines and that can also be supported by quality care organizations. In this article, we review some of the questions that need to be resolved through consensus and review of the evidence, and discuss some of the limitations in analyzing and reporting inpatient glucose data that must be addressed (or at least accepted as limitations) before hospitals can commit resources to gathering, compiling, and presenting inpatient glucose statistics as a health care quality measure. Standards must include consensus on which measures to report, the unit of analysis, definitions of targets for hyperglycemia treatment, a definition of hypoglycemia, determination of how data should be gathered (from chart review or from laboratory information systems), and which type of sample (blood or point of care) should be used for analysis of glycemic control. Hospitals and/or their representatives should be included in the discussion. For inpatient glucose control to remain a focus of interest, further dialogue and consensus on the topic are needed.

BACKGROUNDCross‐sectional data on inpatient glucose control in a large sample of US hospitals are now available, but little is known about changes in glycemic control over time in these institutions.OBJECTIVETo evaluate trends in glycemic control in US hospitals over 2 years.DESIGNRetrospective analysis.METHODSPoint‐of‐care blood glucose (POC‐BG) test results at 126 hospitals during January to December 2007 and January to December 2009 were extracted using the Remote Automated Laboratory System‐Plus (Medical Automation Systems, Charlottesville, VA), and patient‐day‐weighted mean glucose levels were compared.SETTING/PATIENTSHospitalized patients.RESULTSA total of 12,541,929 POC‐BG measurements from 1,010,705 patients were analyzed for 2007, and 10,659,418 POC‐BG measurements from 656,206 patients were analyzed for 2009. Patient‐day‐weighted mean POC‐BG in 2009 decreased by 5 mg/dL in the non‐intensive care unit (non‐ICU) data compared with that in 2007 (154 mg/dL vs 159 mg/dL, respectively; P < 0.001). However, POC‐BG values were clinically unchanged in intensive care unit (ICU) data from 2009 vs 2007 (167 mg/dL vs 166 mg/dL; P < 0.001). From 2007 to 2009, the proportion of patient‐day‐weighted mean POC‐BGs that were >180 mg/dL declined from 28% to 25% in non‐ICU patients (P < 0.001), but not in ICU. Decreases in patient‐day‐weighted mean POC‐BG values in non‐ICU patients were significant regardless of hospital size, type, and geographic region (all P < 0.001), but similar decreases were not found in ICU data.CONCLUSIONSIn this first analysis of glucose changes in US hospitals, improvements over 2 years occurred in non‐ICU patients. Ongoing analysis will determine whether this trend continues. Journal of Hospital Medicine 2013;8:121–125. © 2012 Society of Hospital Medicine