Glucometric benchmarking in an Australian hospital enabled by networked glucose meter technology

Objective To assess glucometric outcomes and to estimate the incidence of hypo‐ and hyperglycaemia among non‐critical care inpatients in a major Australian hospital. Design, setting and participants A prospective 10‐week observational study (7 March – 22 May 2016) of consecutive inpatients with diabetes or newly detected hyperglycaemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Point‐of‐care blood glucose ( BG ) data were collected with networked glucose meters. Main outcome measures Glycaemic control, as assessed with three glucometric models (by population, by patient, by patient‐day); incidence of adverse glycaemic days ( AGD s; patient‐days with BG levels below 4 mmol/L or above 15 mmol/L). Results During the study period, there were 465 consecutive admissions of 441 patients with diabetes or newly detected hyperglycaemia, and 9817 BG measurements over 2953 patient‐days. The mean patient‐day BG level was 9.5 mmol/L (SD, 3.3 mmol/L). The incidence of hyperglycaemia was higher than for a United States hospital benchmark (patient‐days with mean BG level above 10 mmol/L, 37% v 32), and that of hypoglycaemia lower (proportion of patient‐days with mean BG level below 3.9 mmol/L, 4.1% v 6.1%). There were 260 (95% CI , 245–277) AGD s per 1000 patient‐days; the incidence was higher in medical than surgical ward patients (290 [ CI , 270–310] v 206 [ CI , 181–230] per 1000 patient‐days). 604 AGD s (79%) were linked with 116 patients (25%). Episodes of hyperglycaemia ( BG above 15 mmol/L) were more frequent before lunch, dinner, and bedtime; 94 of 187 episodes of hypoglycaemia ( BG below 4 mmol/L) occurred between 11 pm and 8 am. Discussion Glucometric analysis supported by networked glucose meter technology provides detailed inpatient data that could enable local benchmarking for promoting safe diabetes care in Australian hospitals.