Transformation of Acute Diabetes Care: The Journey to Advanced Inpatient Diabetes Management Certification

Objective:   To improve the quality of clinical care for patients with diabetes and stress induced hyperglycemia. 

Methods:  An interprofessional team including physicians, nurses, pharmacists, dieticians, and lab chemists developed a strategic plan to improve care for this population.  Key strategies included standardization and reduction in variability of practice, integration of evidence based  order sets, implementation of professional competencies, measurements of clinical outcomes, system and process improvements including insulin delivery and room service, and cultural change.  Additionally, a Diabetes Management Team for patient consultation and treatment has been activated.

Results:  80% of patient glucose readings are in control range of 70-179 mg/dL and the average daily patient glucose is < 140 mg/dL.  UMMC's rate of harm associated with severe hypoglycemia (< 40 mg/dL) is 0.46% and the total hypoglycemia rate (< 70 mg/dL) is 2.1%.  A reduction is readmissions, sternal wound infections in the CABG population, and a reduction in wound infection in orthopedics has been identified.  The University of Minnesota Medical Center, Fairview, received Joint Commission Disease Specific Certification in Advanced Inpatient Diabetes in November of 2009.  It is the first academic health center to achieve this status and the first hospital in Minnesota to do so.

Conclusion:  The debate over optimal blood glucose targets for inpatient glycemic management continues.  However, it is widely accepted that glycemic management is essential for patients with known diabetes and hyperglycemia when acutely ill.  Intentional efforts to reduce practice variations, establish standards of care, and maintain and elevate professional knowledge has resulted in enhanced outcomes, improved customer satisfaction, and transformation of care and culture for the diabetes population.