Association Between a Virtual Glucose Management Service and Glycemic Control in Hospitalized Adult Patients An Observational Study

Background: Inpatient hyperglycemia is common and is linked to adverse patient outcomes. New methods to improve glycemic control are needed. Objective: To determine whether a virtual glucose management service (vGMS) is associated with improved inpatient glycemic control. Design: Cross-sectional analyses of three 12-month periods (pre-vGMS, transition, and vGMS) between 1 June 2012 and 31 May 2015. Setting: 3 University of California, San Francisco, hospitals. Patients: All nonobstetric adult inpatients who underwent point-of-care glucose testing. Intervention: Hospitalized adult patients with 2 or more glucose values of 12.5 mmol/L or greater (>= 225 mg/dL) (hyperglycemic) and/or a glucose level less than 3.9 mmol/L (<70 mg/dL) (hypoglycemic) in the previous 24 hours were identified using a daily glucose report. Based on review of the insulin/glucose chart in the electronic medical record, recommendations for insulin changes were entered in a vGMS note, which could be seen by all clinicians. Measurements: Proportion of patient-days classified as hyperglycemic, hypoglycemic, and at-goal (all measurements >= 3.9 and <= 10 mmol/L [>= 70 and <= 180 mg/dL] during the pre-vGMS, transition, and vGMS periods). Results: The proportion of hyperglycemic patients decreased by 39%, from 6.6 per 100 patient-days in the pre-vGMS period to 4.0 per 100 patient-days in the vGMS period (difference, -2.5 [ 95% CI, -2.7 to -2.4]). The hypoglycemic proportion in the vGMS period was 36% lower than in the pre-vGMS period (difference, -0.28 [ CI, -0.35 to -0.22]). Forty severe hypoglycemic events (<2.2 mmol/L [<40 mg/dL]) occurred during the pre-vGMS period compared with 15 during the vGMS period. Limitation: Information was not collected on patients' concurrent illnesses and treatment or physicians' responses to the vGMS notes. Conclusion: Implementation of the vGMS was associated with decreases in hyperglycemia and hypoglycemia.