title: Association Between a Virtual Glucose Management Service and Glycemic Control in Hospitalized Adult Patients: An Observational Study.
abstract: 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.
  
  
  METHODS
  Cross-sectional analyses of three 12-month periods (pre-vGMS, transition, and vGMS) between 1 June 2012 and 31 May 2015.
  
  
  METHODS
  3 University of California, San Francisco, hospitals.
  
  
  METHODS
  All nonobstetric adult inpatients who underwent point-of-care glucose testing.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Information was not collected on patients' concurrent illnesses and treatment or physicians' responses to the vGMS notes.
  
  
  CONCLUSIONS
  Implementation of the vGMS was associated with decreases in hyperglycemia and hypoglycemia.
  
  
  BACKGROUND
  National Institutes of Health, the Wilsey Family Foundation, and the UCSF Clinical & Translational Science Institute.
authors.affiliation: From University of California, San Francisco, San Francisco, California.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Rushakoff
authors.affiliation: From University of California, San Francisco, San Francisco, California.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Sullivan
authors.affiliation: From University of California, San Francisco, San Francisco, California.
authors.forename: Heidemarie Windham
authors.initials: HW
authors.lastname: MacMaster
authors.affiliation: From University of California, San Francisco, San Francisco, California.
authors.forename: Arti D
authors.initials: AD
authors.lastname: Shah
authors.affiliation: From University of California, San Francisco, San Francisco, California.
authors.forename: Alvin
authors.initials: A
authors.lastname: Rajkomar
authors.affiliation: From University of California, San Francisco, San Francisco, California.
authors.forename: David V
authors.initials: DV
authors.lastname: Glidden
authors.affiliation: From University of California, San Francisco, San Francisco, California.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kohn
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006761:Hospitals / Q000592:standards; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000188:drug therapy*; D007003:Hypoglycemia / Q000175:diagnosis / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D012495:San Francisco
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin