Blood glucose monitoring during hospitalisation: Advanced practice nurse and semi-automated insulin prescription tools

• Published in: Endocrinología, diabetes y nutrición. diabetes y nutrición., 2022-08, Vol.69 (7), p.500-508
• Main Authors: Yago-Esteban, Gema, Venturas, Montse, Blanco, Jesús, Pérez, Inma, Falces, Carlos, Roqué, Mercè, Yugueros, Xavier, Cardete, Laura, Renu, Arturo, Caellas, David, Conget, Ignacio, Ortega, Emilio
• Format: Article
• Language: English
• Subjects: Advanced nurse practitioner; Blood Glucose - metabolism; Blood Glucose Self-Monitoring; Diabetes mellitus; Educación terapéutica; Enfermera de práctica avanzada; Glycated Hemoglobin; Hiperglucemia; Hospital; Hospitalization; Humans; Hyperglycemia; Insulin - therapeutic use; Mellitus diabetes; Prescriptions; Therapeutic education
• ISSN: 2530-0180; 2530-0180
• DOI: 10.1016/j.endien.2022.07.008

Hyperglycemia is very common in hospitalized patients and is associated with worse clinical outcomes. We implemented a clinical and educational program to improve the overall glycemic control during hospital admission, and, in patients with HbA1c > 8%, to improve their metabolic control after hospital admission. Non-critical patients admitted to cardiovascular areas between October-2017 and February-2019. The program was led by an advanced nurse practitioner (ANP) and included a semiautomated insulin prescription tool. Program in 3 phases: 1) observation of routine practice, 2) implementation, and 3) follow-up after discharge. During the implementation phase the availability of HbA1c increased from 42 to 81%, and the ANP directly intervened in 73/685 patients (11%), facilitating treatment progression at discharge in 48% (de novo insulin in 36%). One-year after discharge, HbA1c in patients who were admitted during the observation phase with HbA1c > 8% (n = 101) was higher than similar patients admitted during implementation phase (8,6 ± 1,5 vs. 7,3 ± 1,2%, respectively, p