Diabetes is one of the common diseases among inpatients in non-endocrinology department. Patients with diabetes require assistance from endocrinologists in their blood glucose management.
To investigate consultation of blood glucose management for inpatients with diabetes in non-endocrinology department and analyze the quality of consultation and the needs of patients.
The inpatients with diabetes in non-endocrinology department consulted by the endocrinologists in West China Hospital, Sichuan University from January 1, 2013 to May 23, 2019 were selected and reviewed. The consultation and medical record information was recorded and organized. The recommended medications for the patients were analyzed to determine the potential contraindications according to drug instructions.
During the study period, we identified 145 428 inpatients with diabetes in non-endocrinology department, 24 499 of them had 31 369 consultations from endocrinologists (0.17 consultations/inpatients), and 20 486 of them had 24 343 consultations for blood glucose management (0.17 consultations/inpatients). The top three departments with the most blood glucose management consultations per patient were neurology (0.30 consultations/inpatients), respiratory medicine (0.25 consultations/inpatients), and cardiology (0.18 consultations/inpatients). There were 18 306 blood glucose management consultations (16 269 inpatients) with complete suggestions, and the most commonly recommended hypoglycemic regimen was the combination of insulin with a meal and basal insulin, accounting for 32.34% (5 921/18 306). Among the all consultations, 1.16% (212/18 306) patients' hypoglycemic regimens had drug contraindications.
A large number of inpatients with diabetes in non-endocrinology department need specialized blood glucose management. The overall quality of the consultation for blood glucose management is relatively high but far from meeting the management requirements.
The increased clinical demand for glycemic control in hospitalized patients has led to a new transformation of clinical technologies and medical models, which has brought challenges to medical management. We built an active blood glucose intervention operation and management model for inpatients using the Plan-Do-Check-Action (PDCA) cycle: Firstly, we concertized the practical management problems through root cause analysis, namely man - machine - material - method - environment. Then, we used PDCA cycle quality management tools to facilitate the construction of the operation and management models based on the PDCA cycle. We finally formed an efficient multidepartment cooperation mechanism and tiered management system and process for inpatients, and established an information system of glycemic management, quality control system and operational performance guarantee system. By use of the model, the blood glucose management has been successfully promoted with some achievements obtained, and the rate of blood glucose meeting the target level within 72 hours after glycemic management has increased month by month in West China Hospital, Sichuan University. This model developed by our hospital may be used as a reference for other hospitals to conduct glycemic management, and it also has great significance for improving the inpatient blood glucose management.
Early intervention of blood glucose control in patients with new-onset type 2 diabetes mellitus (T2DM) can help delay the progression of diabetes. As a new form of health management, the effect of human-computer interaction intelligent blood glucose monitoring management on the progression of new-onset T2DM patients has not been clarified.
To explore the effect of human-computer interaction intelligent management on blood glucose control and self management capability in new-onset T2DM patients, so as to provide the reference for optimizing the control strategy in new-onset T2DM patients.
From June 2016 to December 2016, 200 patients with new-onset T2DM admitted to the Tianjin Medical University, Chu Hsien-I Memorial Hospital were selected by convenient sampling and randomly divided into the control group (n=100) and the monitoring group (n=100). The interventions in the monitoring group were the same as those in the control group except for the human-computer interaction intelligent monitoring. Blood glucose indexes〔fasting blood glucose (FBG), 2 h postprandial glucose (2 hPG) and glycated hemoglobin (HbA1c) 〕and self-management capability indexes〔diabetes management self-efficacy scale (DMSES), summary of diabetes self-care activities (SDSCA), diabetes self-care scale (2-DSCS) 〕were recorded at the time of enrollment and after 3 months of follow-up in the two groups.
After 3 months of follow-up, the monitoring group included 95 cases, the control group included 97 cases. Compared with the pre-intervention period, FBG, 2 hPG and HbA1c levels decreased in both groups after the intervention (P<0.05), and the scores of DMSES scores increased in both groups (P<0.05). FBG, 2 hPG and HbA1c were significantly lower in the post-intervention period of glucose monitoring group compared with the control group (P<0.05). 67 patients (70.5%) in the monitoring group reached the target level of FBG, 31 patients (32.0%) in the control group as well; besides 49 patients (51.6%) in the monitoring group reached the target level of 2 hPG, 30 patients (30.9%) in the control group as well; moreover, 67 patients (70.5%) in the monitoring group reached the target level of HbA1c, 29 cases (29.9%) in the control group as well, all the above rates of reaching in the monitoring group was higher than those in the control group (P<0.05). The total DMSES score, 2-DSCS score and SDSCA score in the monitoring group were higher than those in the control group (P<0.05). The score of DMSES in new-onset T2DM patients was positively correlated with the scores of 2-DSCS and SDSCA (rs=0.909, 0.872, P<0.01). The 2-DSCS scale score was positively correlated with the SDSCA scale score (rs=0.917, P<0.01). Multiple regression analysis showed that diet control, regular exercise, taking medication as instructed, blood glucose monitoring, prevention and management of high and low blood glucose behaviors were favorable factors for HbA1c reduction (P<0.05). The general diet, special diet and taking medication as instructed were the favorable factors for FBG and 2 hPG levels reduction (P<0.05), and the blood glucose monitoring was positive for 2 hPG levels reduction.
Human-computer interaction intelligent management was able to improve blood glucose control of new-onset T2DM patients effectively, which can promote the reaching to target blood glucose level, the subjective initiative of health behavior mainly through improving compliance of blood glucose monitoring, healthy diet, exercise and taking medication as instructed, which provide advice on effective intervention methods for new-onset T2DM patient management.
Inpatient hyperglycemia is common in clinical practice, and is associated with various in-hospital adverse outcomes, increased mortality in critically ill patients, and prolonged hospital stay in non-critically ill patients. Currently, guidelines in endocrinology and metabolism at home and abroad all recommend systematic management of inpatient hyperglycemia, and highlight the principle of individualized management, namely, recommend that glycemic targets should be set individualized based on the patient's individual characteristics. We reviewed the definition, management status, glycemic targets and monitoring methods of inpatient hyperglycemia in worldwide guidelines, and discussed the advances in inpatient hyperglycemia management from a perspective of comparing the similarities and differences in glycemic targets set for different types of inpatient populations and for inpatients with different conditions. This review clearly indicates that the inpatient management of hyperglycemia still needs to adhere to the principle of individualized management, thereby reducing the incidence of complications and all-cause mortality related to hyperglycemia.
