"Glucometrics"--assessing the quality of inpatient glucose management.
BACKGROUND
For patients with diabetes, the quality of outpatient glycemic control is readily assessed by hemoglobin A1c. In contrast, standardized measures for assessing the quality of blood glucose (BG) management in hospitalized patients are lacking. Because of recent studies demonstrating the benefits of strict glycemic control in critically ill patients, hospitals nationwide are dedicating resources to address this important issue. To facilitate advances in this nascent field, standardized metrics for inpatient glycemic control should be developed and validated.


METHODS
We used 1 month of fingerstick BG levels from a general hospital ward to develop and test three analytic models, based on three units of inpatient BG analysis: population (i.e., ward), patient-day, and patient. To assess the effect of the source of blood samples, we repeated these analyses after adding venous plasma glucose levels. Finally, we employed an idealized intensive care unit data set to establish "gold standard" metrics for inpatient glycemic control.


RESULTS
Mean and median BG levels and the proportion of BG levels within an "optimal" range (80-139 mg/dL) were similar among the three models, whereas hypoglycemic and hyperglycemic event rates varied considerably. Inclusion of venous glucose levels did not substantially affect the results. Of the three models tested, the patient-day model appears to most faithfully reflect the quality of inpatient glycemic control. Achieving 85% of BG levels within optimal range may be considered gold standard.


CONCLUSIONS
If validated elsewhere, these "glucometrics" would permit objective comparisons of inpatient glycemic control among hospitals and patient care units, and would allow institutions to gauge the success of their quality improvement initiatives.
Goldberg
Philip A
PA
Section of Endocrinology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Bozzo
Janis E
JE
Thomas
Prem G
PG
Mesmer
Melinda M
MM
Sakharova
Olga V
OV
Radford
Martha J
MJ
Inzucchi
Silvio E
SE
D001786:Blood Glucose / Q000032:analysis*; D001800:Blood Specimen Collection / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000628:therapy; D006760:Hospitalization; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D008991:Monitoring, Physiologic / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D012015:Reference Standards
D001786:Blood Glucose