The Effect Of The Strategies Adjustment Based On The Bedside Blood Glucose Data On Glycemic Management Quantity In Hospitalized Diabetic Patients

Objective:To evaluate the value of the glycemic management strategies adjustment which is based on the data collected from the hospital blood glucose monitoring system(BGMS)in the improvement of the glycemic management quality in hospitalized diabetic patients.Method:3432 and 1292 cases,who were respectively hospitalized in theEndocrinology Department from January 2008 to December 2011 and from January 2014 to December 2015 were enrolled in this study,and their 196781 and 64330 times of blood glucose were collected with the usage of the hospital blood glucose monitoring system.We then retrospectively analyzed and compared these date with several glycemic evaluation models,such as the Population、Patient、Patient-day and Quality Hyperglycemia Score models.Result:After adjusting the management strategies such as the way to monitoring blood glucose and the goal of blood glucose before sleeping from year 2013,which is based on the the blood glucose data colledted from January 2008 to December 2011,compared with year 2008-2011,the diabetic patients who were hospitalized between year 2014-2015 were:① The average hospitalization days decreased by 0.95 days(10.62±6.69 vs 11.57±6.62,p<0.001),the glycemic monitoring times decreased by 7.55 times per capita(49.79±27.94 vs 57.34±31.31,p<0.001),the glycemic monitoring times decreased by 0.43 times daily(5.05±2.00 vs 5.48±2.05,p<0.001);②The monitoring times of blood glucose of nocturnal and pre-lunch period,which is the high time of hypoglycemia,increased by 32.11%(11.72%vs 8.71%,p<0.001)and 12.15%(11.72%vs 10.45%,p<0.001)respectively,and the monitoring times of the post-lunch and post-dinner period,which is the low period of hypoglycemia,have respectively decreased(p<0.05);③Hypoglycemic and severe hypoglycemic events respectively decreased by 7.63%(1.09%vs 1.18%,p=0.051)and 18.75%(0.13%vs 0.16%,p=0.073);The proportion of patients who even suffered from hypoglycemia and severe hypoglycemia respectively decreased by 13.37%(27.01%vs 31.18%,p=0.005)and 33.48%(4.65%vs 6.99%,p=0.003);Patients-days which with hypoglycemia and severe hypoglycemia respectively decreased by 14.16%(4.97%vs 5.79%,p=0.001)and 24.71%(0.64%vs 0.85%,p=0.020);The proportion of the patients who suffered from recurrent hypoglycemia(>3 times)decreased by 37.14%of the total(2.86%vs 4.55%,p=0.009);④ The density of the occurrence of hypoglycemia of pre-lunch,after-lunch,pre-supper,before-sleep period respectively decreased by 32.98%(1.26%vs 1.88%,p<0.001),44.29%(0.39%vs 0.70%,p=0.004),32.53%(0.56%vs 0.83%,p=0.007)and 36.96%(0.58%vs 0.92%,p=0.001);the proportion of the patients who even suffered from hypoglycemia in after-breakfast,pre-lunch,after-lunch,pre-supper,before-sleep period respectively decreased by 25.83%(5.11%vs 6.89%,p=0.027),29.89%(6.59%vs 9.40%,p=0.003),57.29%(1.67%vs 3.91%,p<0.001),29.05%(4.20%vs 5.92%,p=0.021)and 36.99%(4.19%vs 6.65%,p=0.002);⑤Compared with the the earlily period of the hospitalization,in the later period of the hospitalization,the improvement in the degree of hypoglycemia,hyperglycemia and the fluctuation of the blood glucose could be greater,and the QHS score improved greatlier.⑥The nocturnal,pre-breakfast and pre-lunch period are still the high time of the occurrence of hypoglycemia;The after-lunch and before-sleep period are still the high time of the occurrence of hyperglycemia;⑦The proportion of the patients who suffered from severe hyperglycemia events was similar to the previous,but severe hyperglycemia events and patient-days with severe hyperglycemia events respectively increased by 11.82%(8.61%vs 7.70%,p<0.001)and 8.16%(24.51%vs 22.66%,p<0.001);⑧The patients with type 1 diabetes and the elderly(≥60 years old)have the higher risk of hypoglycemia.The decrease of the hypoglycemia were mainly in the patients with type 2 diabetes,the non-elderly(≤59 years old)and the male.Conclusion:Take full advantage of the informationize BGMS data to analyze and evaluate the quality of clinical glycemic management,and to explore the influencing factors of glycemic control regularly to guide the adjustment and improvement of glycemic management strategies,can help greatly improve the quality of glycemic management in hospitalized diabetic patients.