title: DAILY INPATIENT GLYCEMIC SURVEY (DINGS): A PROCESS TO REMOTELY IDENTIFY AND ASSIST IN THE MANAGEMENT OF HOSPITALIZED PATIENTS WITH DIABETES AND HYPERGLYCEMIA.
abstract: OBJECTIVE
  Hyperglycemia, hypoglycemia, and glycemic variability have been associated with increased morbidity, mortality, and overall costs of care in hospitalized patients. At the Stratton VA Medical Center in Albany, New York, a process aimed to improve inpatient glycemic control by remotely assisting primary care teams in the management of hyperglycemia and diabetes was designed.
  
  
  METHODS
  An electronic query comprised of hospitalized patients with glucose values <70 mg/dL or >350 mg/dL is generated daily. Electronic medical records (EMRs) are individually reviewed by diabetes specialist providers, and management recommendations are sent to primary care teams when applicable. Glucose data was retrospectively examined before and after the establishment of the daily inpatient glycemic survey (DINGS) process, and rates of hyperglycemia and hypoglycemia were compared.
  
  
  RESULTS
  Patient-day mean glucose slightly but significantly decreased from 177.6 ± 64.4 to 173.2 ± 59.4 mg/dL (P<.001). The percentage of patient-days with any value >350 mg/dL also decreased from 9.69 to 7.36% (P<.001), while the percentage of patient-days with mean glucose values in the range of 90 to 180 mg/dL increased from 58.1 to 61.4% (P<.001). Glycemic variability, assessed by the SD of glucose, significantly decreased from 53.9 to 49.8 mg/dL (P<.001). Moreover, rates of hypoglycemia (<70 mg/dL) decreased significantly by 41% (P<.001).
  
  
  CONCLUSIONS
  Quality metrics of inpatient glycemic control improved significantly after the establishment of the DINGS process within our facility. Prospective controlled studies are needed to confirm a causal association.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Mendez
authors.forename: Ashar
authors.initials: A
authors.lastname: Ata
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Rourke
authors.forename: Steven C
authors.initials: SC
authors.lastname: Stain
authors.forename: Guillermo
authors.initials: G
authors.lastname: Umpierrez
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003920:Diabetes Mellitus / Q000097:blood* / Q000628:therapy; D019468:Disease Management; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000628:therapy; D007003:Hypoglycemia / Q000097:blood* / Q000628:therapy; D007297:Inpatients; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose