| Objective: To investigate the status of blood glucose management in hyperglycemia hospitalized in non-endocrinology wards,analyze the shortcomings of traditional blood glucose management,and evaluate the effect of information-based blood glucose management on the quality and efficiency indicators of blood glucose management in nonendocrinology wards,so as to provide guidance for further optimization of blood glucose management.Methods: Patients hospitalized in the non-endocrinology wards of Zhejiang Provincial People’s Hospital from 2020-07-12 to 2020-07-18 and from 2022-03-13 to 2022-03-19 were selected as the subjects of this study,and they were divided into traditional blood glucose management mode and information-based blood glucose management mode according to whether information-based blood glucose management was implemented or not.To investigate the detection of hyperglycemia and the current status of blood glucose management under the traditional blood glucose management mode.The hyperglycemia hospitalized in the non-endocrinology wards from 2020-07-12 to 2020-07-18 were named as the traditional blood glucose management group(n=186),and the hyperglycemia detected from 2022-03-13 to 2022-03-19 were named as the information-based blood glucose management group(n=165).To compare the differences in quality indicators of blood glucose management(glycosylated hemoglobin A1c(Hb A1c)detection rate,terminal blood glucose monitoring rate and frequency of monitoring,endocrinology consultation rate,microvascular/macrovascular screening rates,dysglycemia diagnosis rate,endocrinology follow-up notification rate and diet education rate)and efficiency indicators(fasting blood glucose(FBG)compliance rate and average FBG compliance days,time in range(TIR)compliance rate,length of hospital stay,hospital expenses and incidence of infection)between the two groups.Results: 1.Detection of hyperglycemia and the status of blood glucose management in nonendocrinology wards under the traditional blood glucose management modeThe detection rate of hyperglycemia was 10.3%(186/1806),of which the rates of Hb A1 c detection,terminal blood glucose monitoring,endocrinology consultation,micr ovascular/macrovascular screening rates,diagnosis of dysglycemia,endocrinology follo w-up notification,diet education,FBG compliance and TIR compliance were 26.3%,52.7%,14.0%,4.8%,43.5%,45.7%,12.4%,10.2%,35.0%,37.1%,respectively.The average daily frequency of blood glucose monitoring was 3.7±1.1 times per day and the average FBG compliance days were 5.5±4.8 days.The median length of hospital stay and median hospital cost in hyperglycemia were significantly higher than those in normoglycemia(P<0.05).The detection rate of perioperative hyperglycemia was 8.8%(96/1087),of which the rates of Hb A1 c detection,peripheral blood glucose monitoring,preoperative FBG monitoring,endocrinology consultation,diagnosis of dysglycemia,endocrinology follow-up notification,diet education and TIR compliance were 26.0%,47.9%,20.8%,14.6%,39.6%,4.2%,7.3% and 36.5%,respectively.The average daily frequency of blood glucose monitoring was 3.8±1.0 times/day.The median length of hospital stay,median hospital costs and infection rates in perioperative hyperglycemia were significantly higher than those in normoglycemia(P<0.05).The rates of Hb A1 c detection,peripheral blood glucose monitoring,diagnosis of dysglycemia and TIR compliance of hyperglycemia in the internal wards(38.6%,70.6%,64.8% and 52.3%)were higher than in surgical wards(15.3%,36.7%,28.5% and 23.5%)(P< 0.05).Compared with patients without endocrinology consultation,patients with hyperglycemia who received endocrinology consultation had higher rates of Hb A1 c detection(76.9% vs.18.1%),peripheral blood glucose monitoring(96.2% vs.45.6%),adjusting glucose-lowering regimen rate(84.6% vs.31.9%),insulin utilization rate(57.7%vs.3.1%),diagnostic rate of dysglycemia(76.9% vs 40.6%),endocrinology follow-up notification rate(46.2% vs 6.9%),diet education rate(23.1% vs 8.1%),FBG compliance rate(65.4% vs 30.0%),and TIR compliance rate(61.5% vs 33.1%)(P < 0.05).Hyperglycemia diagnosed with dysglycemia had higher rates of Hb A1 c detection(40.0% vs 14.9%),peripheral blood glucose monitoring(85.9% vs.24.8%),endocrinology consultation(23.5% vs.5.9%),adjusting glucose-lowering regimen(71.8% vs.11.9%),insulin use(20.0% vs.3.0%),microvascular screening(9.4% vs 1.0%),endocrinology follow-up consultation(20.0% vs 5.9%),diet education rate(18.8% vs 3.0%),FBG compliance rate(52.9% vs 19.8%)and TIR compliance rate(62.4% vs 15.8%)than those without a diagnosis of dysglycemia(P <0.05).2.Comparison of quality and efficiency indicators of blood glucose management under the information-based blood glucose management or under the traditional blood glucose management modeThe quality and efficiency indicator of information-based blood glucose management for non-endocrinology hyperglycemia were better than those of traditional blood glucose management,including Hb A1 c detection rate(39.4% vs 26.3%),endocrinology consultation rate(27.9% vs 14.0%),insulin and insulin pump utilization rate(29.7% vs 10.8%,9.1% vs1.1%),and TIR compliance rate(47.6% vs 37.1%),and the difference was statistically significant(P < 0.05).Compared with traditional blood glucose management,the information-based blood glucose management in perioperative hyperglycemia showed significant improvements in Hb A1 c detection rate(40.5% vs 26.0%),peripheral blood glucose monitoring rate(64.9% vs47.9%),endocrinology consultation rate(37.8% vs 14.6%),adjusting glucose-lowering regimen rate(47.3% vs 13.5%),insulin and insulin pump utilization rate(33.8% vs 12.5%,12.2% vs 1.0%)and average compliant FBG time(5.1±1.9 vs 5.3±4.2)(P < 0.05).After information-based glucose management,the rates of insulin utilization and endocrinology follow-up consultation(29.9% vs 14.8% and 29.9% vs 15.9%)were significantly higher among hyperglycemia in the internal wards than traditional blood glucose management(P < 0.05).Among surgical hyperglycemia,the rates of Hb A1 c detection,peripheral blood glucose monitoring,endocrinology consultation,insulin utilization,diagnosis of dysglycemia,and adjusting glucose-lowering regimen,insulin use rate,diagnosis of dysglycemia,endocrinology follow-up consultation(31.8% vs 15.3%,55.7% vs 36.7%,30.7% vs 11.2%,31.8% vs 13.2%,29.5% vs 7.1%,48.9% vs 28.6%,21.6%vs 7.1%)and median FBG compliance time(6.0(10.2)vs 8.0(13.0))were all higher than those of traditional blood glucose management(P < 0.05).Conclusion: The detection rate of hyperglycemia hospitalized in non-endocrinology wards is high and the traditional blood glucose management mode has many shortcomings such as low detection rate,low consultation rate,low treatment rate and low compliance rate.The information-based blood glucose management can effectively improve the quality and efficiency of blood glucose management for hyperglycemia in non-endocrinology wards,and it has good practicality and application prospects. |
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