Common Models Used for Inpatient Diabetes Management
- 23 Downloads
Purpose of Review
Diabetes affects about a third of all hospitalized patients and up to 50% of inpatients go on to experience hyperglycemia. Despite strong evidence supporting the importance of adequate glycemic control, as well detailed guidelines from major national organizations, many patients continue to have hypo- and hyperglycemia during their hospital stay. While this may be partially related to provider and patient-specific factors, system-based barriers continue to pose a major obstacle. Therefore, there is a need to go beyond merely discussing specific insulin protocols and provide guidance for effective models of care in the acute glycemic management of hospitalized patients.
To date, there is limited data evaluating the various models of care for inpatient diabetes management in terms of efficacy or cost, and there is no summary on this topic guiding physicians and hospital administrators.
In this paper, four common models of inpatient diabetes care will be presented including those models led by the following: an endocrinologist(s), mid-level provider(s), pharmacist(s), and a virtual glucose management team. The authors will outline the intrinsic benefits as well as limitations of each model of care as well as cite supporting evidence, when available. Discussion pertaining to how a given model of care shapes and formulates a particular organization’s structured glucose management program (GMP) will be examined. Furthermore, the authors describe how the model of care chosen by an institution serves as the foundation for the creation of a GMP. Finally, the authors examine the critical factors needed for GMP success within an institution and outline the nature of hospital administrative support and accompanying reporting structure, the function of a multidisciplinary diabetes steering committee, and the role of the medical director.
KeywordsModels of care Diabetes Hospitalized patients Inpatient diabetes management Glucose management program Hospital infrastructure
Compliance with Ethical Standards
Conflict of Interest
Andjela Drincic, Padmaja Akkireddy, and Jon Knezevich declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Herman WH, Zimmet P. Type 2 diabetes: an epidemic requiring global attention and urgent action. Diabetes Care. 2012;35(5):943–4.Google Scholar
- 2.Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017.Google Scholar
- 3.Donnan PT, Leese GP, Morris AD, Diabetes A, Research in Tayside SMMUC. Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of Tayside, Scotland: a retrospective cohort study of resource use. Diabetes Care. 2000;23(12):1774–9. https://doi.org/10.2337/diacare.23.12.1774.CrossRefPubMedGoogle Scholar
- 5.Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38. https://doi.org/10.1210/jc.2011-2098.CrossRefPubMedGoogle Scholar
- 6.ADA standards of care 2017. Diabetes Care 2017 Jan ; 40 (Supplement 1).Google Scholar
- 12.• Rajendran R, Round RM, Kerry C, Barker S, Rayman G. Diabetes patient at risk score—a novel system for triaging appropriate referrals of inpatients with diabetes to the diabetes team. Clin Med (Lond). 2015;15(3):229–33. This study provides a scoring system to identify patients who would beneft from diabetes team consultation. https://doi.org/10.7861/clinmedicine.15-3-229.CrossRefGoogle Scholar
- 14.Pietras SM, Hanrahan P, Arnold LM, Sternthal E, McDonnell ME. State-of-the-art inpatient diabetes care: the evolution of an academic hospital. Endocr Pract. 2010;16(3):512–21. https://doi.org/10.4158/EP09319.CO.
- 15.Munoz M, Pronovost P, Dintzis J, Kemmerer T, Wang NY, Chang YT, et al. Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice. Jt Comm J Qual Patient Saf. 2012;38(5):195–206. https://doi.org/10.1016/S1553-7250(12)38025-2.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.• Rushakoff RJ, Sullivan MM, MacMaster HW, Shah AD, Rajkomar A, Glidden DV, et al. Association between a virtual glucose management service and glycemic control in hospitalized adult patients: an observational study. Ann Intern Med. 2017;166(9):621–7. Recent study evaluating the effect of remote monitoring on glycemic control. https://doi.org/10.7326/M16-1413.CrossRefPubMedGoogle Scholar
- 18.Mendez CE, Ata A, Rourke JM, Stain SC, Umpierrez G. Daily inpatient glycemic survey (Dings): a process to remotely identify and assist in the management of hospitalized patients with diabetes and hyperglycemia. Endocr Pract. 2015;21(8):927–35. https://doi.org/10.4158/EP14577.OR.CrossRefPubMedGoogle Scholar
- 20.Shea S, Weinstock RS, Teresi JA, Palmas W, Starren J, Cimino JJ, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. J Am Med Inform Assoc. 2009;16(4):446–56. https://doi.org/10.1197/jamia.M3157.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Desimone ME, Blank GE, Virji M, Donihi A, DiNardo M, Simak DM, et al. Effect of an educational Inpatient Diabetes Management Program on medical resident knowledge and measures of glycemic control: a randomized controlled trial. Endocr Pract. 2012;18(2):238–49. https://doi.org/10.4158/EP11277.OR.CrossRefPubMedGoogle Scholar
- 28.• Mackey PA, Boyle ME, Walo PM, Castro JC, Cheng MR, Cook CB. Care directed by a specialty-trained nurse practioner or physician assistant can overcome clinical inertia in management of inpatient diabetes. Endocr Pract. 2014;20(2):112–9. This study evaluated a model led by cross trained mid level providers in inpatient diabetes management. https://doi.org/10.4158/EP13201.OR.CrossRefPubMedGoogle Scholar
- 32.• Mularski KS, Yeh CP, Bains JK, Mosen DM, Hill AK, Mularski RA. Pharmacist glycemic control team improves quality of glycemic control in surgical patients with perioperative dysglycemia. Perm J. 2012;16(1):28–33. This study evaluated how a pharmacist-led model of care impacted postoperative glycemic outcomes in surgical patients. CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Joint Commission Perspectives®, July 2016. 36(7):1–8.Google Scholar
- 44.American College of Endocrinology and American Diabetes Association Consensus statement on inpatient diabetes and glycemic control. Diabetes Care. 2006;29(8):1955–62.Google Scholar
- 46.Mathioudakis N, Pronovost PJ, Cosgrove SE, Hager D, Golden SH. Modeling inpatient glucose management programs on hospital infection control programs: an infrastructural model of excellence. Jt Comm J Qual Patient Saf. 2015;41(7):325–36. https://doi.org/10.1016/S1553-7250(15)41043-8.CrossRefPubMedPubMedCentralGoogle Scholar