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

The increased costs associated with the management of mild to moderate hyperglycemia in the hospital are unnecessary and can be decreased with treatment in an outpatient setting by a standardized treatment protocol.

A nurse practitioner-led clinic provides care to patients with uncontrolled diabetes who are uninsured and often present in hyperglycemic states that could be managed outpatient to prevent hospital utilization. This quality improvement project focused on the initial implementation of an evidence-based protocol to help standardize management of mild-to-moderate hyperglycemic crisis.

An evidence-based protocol for treating critically high blood glucose (BG) values (≥350 mg/dl) for in-person visits was developed using incremental doses of rapid-acting insulin, monitoring of basic metabolic profile, and oral hydration.

The protocol was presented to nurse practitioners and essential staff. Implementation of the protocol was evaluated with attention to provider adherence and patients' resulting BG values.

A total of 39 patient cases were managed with the protocol: 12 were assessed to be adherent to the protocol and 27 were not. Overall, the BG levels in both groups decreased to safer levels after implementation of the protocol. Provider adherence to the protocol made a clinically relevant difference in BG levels, and patients' hyperglycemia was controlled more safely in the adherent group compared with the nonadherent group.

This protocol can help safely control high BG levels in an outpatient setting and prevent hospital visits to control hyperglycemic crises. Ensuring provider adherence to the protocol is essential for achieving these outcomes.