BOSTON, November 2, 2023 – Doctors are increasingly realizing that “one size fits all” doesn’t work when it comes to managing blood sugar in hospitalized patients, especially those who are frail. A recent quality advancement project at a major academic medical center found that adjusting glucose targets based on a patient’s overall health status considerably reduced dangerous drops in blood sugar.
Personalized Glucose Control Cuts Hypoglycemia Risk
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A new approach to inpatient diabetes management focuses on individual patient frailty to minimize dangerous blood sugar lows.
- Adjusting blood sugar targets for frail patients can prevent hypoglycemia.
- The study took place at Beth Israel Deaconess Medical Center in Boston.
- Researchers saw a 44% reduction in hypoglycemia events after implementing the new protocol.
- The project spanned from January 2022 to December 2022.
What’s the best way to manage blood sugar in the hospital? The answer, it turns out, isn’t a fixed number, but a personalized target that considers how robust a patient is overall. This is especially crucial for older adults and those with multiple health conditions.
The Problem with Standard Targets
For years, hospitals have generally aimed for blood glucose levels between 140 and 180 milligrams per deciliter (mg/dL) for most inpatients. However, this approach often leads to hypoglycemia – dangerously low blood sugar – notably in patients who are frail, meaning they have reduced physiological reserves and are more vulnerable to adverse events. Hypoglycemia can cause confusion, falls, and even cardiac events.
A Quality Improvement Initiative at Beth Israel Deaconess
Researchers at Beth Israel Deaconess Medical Center in Boston implemented a quality improvement project between January 2022 and December 2022 to address this issue. They categorized patients as frail, intermediate, or non-frail based on a validated clinical frailty score.For frail patients, the target range was adjusted upwards to 180-200 mg/dL. Intermediate patients had a target of 160-180 mg/dL, while non-frail patients maintained the standard 140-180 mg/dL range.
Results Show a Dramatic Improvement
The results, published in Cureus, demonstrated a considerable impact. The incidence of hypoglycemia decreased from 18.8% to 10.5% after the new protocol was implemented. There was no corresponding increase in hyperglycemia (high blood sugar) events. The study also highlighted the importance of understanding frailty and its impact on patient care.
