Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Use of a glucose alert pathway and connectivity blood glucose meters reduces inattention to hospital diabetes management (#86)

Mervyn Kyi 1 2 , Peter G Colman 1 , Paul R Wraight 1 , Lois M Rowan 1 , Katie A Marley 1 , Spiros Fourlanos 1
  1. The Royal Melbourne Hospital, Parkville, VIC, Australia
  2. Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia


In hospitalised patients, hypoglycaemia and hyperglycaemia are associated with worse outcomes. Clinical inertia & inattention to diabetes are major barriers to achieving optimal glycaemic control. We investigated the effect of a novel Glucose Alert Pathway (GAP) and Connectivity Blood Glucose Meter (CBGM) technology on nursing & medical staff action in response to suboptimal glycaemia.


The study was a 3-months prospective, pre- & post- implementation audit on two wards at a tertiary hospital. The intervention consisted of two components: GAP (paper-based glucose management & clinical escalation guide) coupled with CBGM. Consecutive inpatients with diabetes were assessed for BGL measures, diabetes treatment & hospital outcomes. The primary outcome was appropriate staff action on patient-days with reportable BGLs (defined as BGL <4.0, or >15.0, or two consecutive BGL >10.0 mmol/L). Appropriate nursing staff action was defined as notifying medical staff. Appropriate medical staff action was defined as reviewing or adjusting diabetes treatment. Secondary outcomes were adverse glycaemic days (patient-days with BGL <4.0 or >15.0 mmol/L), and hospital complications.


We recruited 157 patients (359 patient-days during baseline, and 311 patient-days during intervention periods). Reportable BGLs occurred in 148 (42%) and 114 (37%) patient-days during baseline and intervention periods respectively (p=0.12). Appropriate nursing staff action increased from 34% at baseline, to 58% at intervention (p<0.001). Similarly, appropriate medical staff action increased from 33% to 50% (p=0.004). However, there was no increase in diabetes medication adjustment (24% vs. 29%, p=0.3) or endocrinology consults (14% vs. 17%, p=0.6). There was a significant 24% decrease in adverse glycaemic days as a proportion of all patient-days (29% vs. 22%, p=0.03) but no difference in hospital complications.


The GAP coupled with CBGM technology, increased nursing & medical staff attention to diabetes. However there was ongoing clinical inertia, with little action to adjust diabetes medications or seek endocrinologist assistance. Overall, the intervention resulted in a significant reduction in adverse glycaemic days.