Kao Shih Ling, Chen Ying, Ning Yilin, Tan Maudrene, Salloway Mark, Khoo Eric Yin Hao, Tai E Shyong, Tan Chuen Seng
Department of Medicine, National University Hospital and National University Health System, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.
Clin Diabetes Endocrinol. 2020 Nov 5;6(1):21. doi: 10.1186/s40842-020-00107-2.
Diabetes mellitus (DM) is one of the most common chronic diseases. Individuals with DM are more likely to be hospitalised and stay longer than those without DM. Inpatient hypoglycemia and hyperglycemia, which are associated with adverse outcomes, are common, but can be prevented through hospital quality improvement programs.
We designed a multi-faceted intervention program with the aim of reducing inpatient hypoglycemia and hyperglycemia. This was implemented over seven phases between September 2013 to January 2016, and covered all the non-critical care wards in a tertiary hospital. The program represented a pragmatic approach that leveraged on existing resources and infrastructure within the hospital. We calculated glucometric outcomes in June to August 2016 and compared them with those in June to August 2013 to assess the overall effectiveness of the program. We used regression models with generalised estimating equations to adjust for potential confounders and account for correlations of repeated outcomes within patients and admissions.
We observed significant reductions in patient-days affected by hypoglycemia (any glucose reading < 4 mmol/L: OR = 0.71, 95% CI: 0.61 to 0.83, p < 0.001), and hyperglycemia (any glucose reading > 14 mmol/L: OR = 0.84, 95% CI: 0.71 to 0.99, p = 0.041). Similar findings were observed for admission-level hypoglycemia and hyperglycemia. Further analyses suggested that these reductions started to occur four to 6 months post-implementation.
Our program was associated with sustained improvements in clinically relevant outcomes. Our described intervention could be feasibly implemented by other secondary and tertiary care hospitals by leveraging on existing infrastructure and work force.
糖尿病（DM）是最常见的慢性病之一。糖尿病患者比非糖尿病患者更有可能住院且住院时间更长。与不良后果相关的住院低血糖和高血糖很常见，但可通过医院质量改进计划加以预防。
我们设计了一项多方面的干预计划，旨在减少住院低血糖和高血糖情况。该计划于2013年9月至2016年1月分七个阶段实施，覆盖一家三级医院的所有非重症监护病房。该计划是一种实用方法，利用了医院现有的资源和基础设施。我们计算了2016年6月至8月的血糖检测结果，并将其与2013年6月至8月的结果进行比较，以评估该计划的整体效果。我们使用带有广义估计方程的回归模型来调整潜在混杂因素，并考虑患者和入院病例中重复结果的相关性。
我们观察到受低血糖影响的患者天数显著减少（任何血糖读数<4 mmol/L：OR = 0.71，95% CI：0.61至0.83，p < 0.001），以及高血糖情况（任何血糖读数>14 mmol/L：OR = 0.84，95% CI：0.71至0.99，p = 0.041）。入院时的低血糖和高血糖情况也有类似发现。进一步分析表明，这些减少在实施后4至6个月开始出现。
我们的计划与临床相关结果的持续改善相关。我们所描述的干预措施可由其他二级和三级医疗机构通过利用现有基础设施和劳动力切实可行地实施。
