Improving response to mild-to-moderate hyperglycemic crisis in the underserved population with diabetes

Area of Science:

• Endocrinology
• Diabetes Management
• Quality Improvement

Background:

• Hospital management of mild to moderate hyperglycemia incurs significant, avoidable costs.
• Outpatient treatment using a standardized protocol offers a cost-effective alternative.
• Nurse practitioner-led clinics can manage uninsured patients with uncontrolled diabetes presenting with hyperglycemic states.

Purpose of the Study:

• To implement and evaluate an evidence-based protocol for standardizing the management of mild-to-moderate hyperglycemic crises in an outpatient setting.
• To reduce hospital utilization for hyperglycemia management.
• To assess provider adherence and patient outcomes.

Main Methods:

• Development of an evidence-based protocol for blood glucose (BG) ≥350 mg/dl, incorporating rapid-acting insulin, metabolic profiling, and oral hydration.
• Presentation of the protocol to nurse practitioners and staff.
• Evaluation of protocol implementation through provider adherence and patient BG level monitoring.

Main Results:

• 39 patient cases were managed; 12 showed adherence and 27 did not.
• Both groups experienced decreased BG levels, indicating protocol effectiveness.
• Higher provider adherence correlated with safer and more effective hyperglycemia control.

Conclusions:

• The protocol safely controls high BG levels in an outpatient setting, preventing hospital visits for hyperglycemic crises.
• Provider adherence is essential for optimizing patient outcomes and ensuring the protocol's success.
• This approach demonstrates the potential for improved diabetes care in underserved populations.