China is the country with the highest number of diabetics in the world (116.4 million)1, and this continues to rise. Yet, the treatment and control rates are relatively low – less than 50%.
There is a need to strengthen the in-and out-of-hospital management of diabetes. In this webinar delivered for the Roche Point of Care Academy, Associate Chief Physician of Endocrinology Dr. Li Xiaobo shares how a connected glucose monitoring system enabled her hospital to track and better manage patients’ blood glucose levels.
The importance and value of blood glucose monitoring
The Second Hospital of Shandong University is a 2000+ bed, Class A, tertiary, comprehensive hospital in China. Before the introduction of a new POCT system, nurses were recording patient data manually, which was creating an information block and issues with quality control.
From October 2019 to May 2021, a blood glucose monitoring system was implemented in more than 32 departments and 117 units in the hospital. Implementing the system required the cooperation of multiple departments, with the endocrinology department being the main force in blood glucose management. In this webinar, Associate Chief Physician of Endocrinology Dr. Li Xiaobo shares what she learned from the process and the improvements it has delivered for patients and staff.
The importance of test frequency
Between 2019 and 2021, the hospital conducted 0.78 million glucose tests, increasing from 14,539 tests per month in 2019 to 50,859 in 2021. There was an average of 1.5 tests per patient per day, with endocrinology completing the most tests per day. The guidelines for the management of type 2 diabetes in China recommend that this should be 4-7 tests per day, so there is a need to increase the test frequency and ensure doctors in all departments understand the importance of multiple test points.
The importance of interdisciplinary cooperation
Based on the data 32% of the tests showed hyperglycemia (blood glucose exceeding 11.1mmol/L), with the highest numbers occurring in endocrinology and neurology. 88% of hyperglycemia cases were distributed in non-endocrinology departments, where patients are not well-managed, highlighting the importance of interdisciplinary cooperation.
The highest proportion of hypoglycemia (blood glucose below 3.9mmol/L) occurred in obstetrics and paediatrics – this may be due to a difference in the normal blood glucose range for pregnant women and babies. Departments with a high proportion of hypoglycemia need to seek consultation and guidance from endocrinology.
Monitoring high-incidence periods
To effectively reduce the incidence of hypoglycemic events, it is necessary to pay attention during high incidence periods.
- Internal medicine system: A high number of events occurred before breakfast, after lunch and after dinner, but the highest proportion occurred between 10pm and the early hours of the morning.
- Surgical system: Events were irregular, perhaps because patients were not able to eat food before/after surgery or were receiving enteral nutrition. Doctors should therefore pay more attention to glucose fluctuation during the day and night, adjust treatment regimens, and consult the endocrinologist.
- ICU patients: There was a high occurrence of night-time hypoglycemia, and more attention should be paid at this time. The patients in the ICU department have severe conditions – they may be in a coma or have a severe infection – and these factors can affect glucose levels.
The impact of monitoring glucose
In a comparison of blood glucose levels two days after admission vs two days before discharge, the proportion of ideal blood glucose was significantly increased, while the incidence of pre-meal and postprandial hyperglycemia was significantly reduced. During the hospital stay, with the blood glucose monitoring and the adjustment of the diabetes treatment regimen, the patient’s control of their blood glucose improved.
Significant improvements after implementation
As Dr. Li Xiaobo highlights, through Cloud Ward Management, the endocrinology department can view comprehensive patient information, including a record of blood glucose tests, which is useful for managing the diabetes of patients in other departments.
In addition, a standardised glucose report has improved the efficiency of the rounds, especially as the majority of patients in endocrinology have diabetes. With the new system, teams can:
- View blood glucose test sheets and test results on a ward basis
- Highlight blood sugar values that need attention
- Check blood sugar levels in real-time with a mobile phone
This facilitates the handover between medical staff, is useful for scientific research and could even contribute to improving medical safety through the real-time monitoring of insulin pumps.