When Cecilia Low Wang, MD was a resident 15 years ago, addressing a hospitalized patient’s blood glucose levels wasn’t a primary concern. But times have changed. Today, as Director of the Glucose Management Team, Dr. Low Wang is on a mission to help inpatient clinical departments improve outcomes through better blood sugar management.
The increased prevalence of diabetes might be widely known, but many in health care aren’t aware that poorly controlled glucose levels in the hospital setting are associated with poor clinical outcomes. It’s a problem for patients previously diagnosed with diabetes—as well as those who are undiagnosed.
“Glucose monitoring is an integral, but sometimes overlooked, part of hospital care,” says Dr. Low Wang. “When people are acutely ill, just those inflammatory conditions—pain, infection, inflammation—can impact blood sugar level.”
Hyperglycemia, or high blood sugar, contributes to short- and long-term medical problems. On the other end of the spectrum, the low glucose levels of hypoglycemia can be deadly.
“There is more and more evidence that says controlling blood sugar in the hospital setting is important, but there are a number of things that can make it difficult,” says Dr. Low Wang. “Changing kidney function, fluid overload, and the transitions a patient experiences in a hospital setting with variations in diet, medications and activity levels—all can impact glucose levels.”
Dr. Low Wang and her team stress that blood sugar management can be complex. For all patients, managing glucose levels properly involves the assessment of many factors—and a constant need for adjustment.
“With glucose, it’s a matter of intensity. In the inpatient world, we don’t want to put people at risk for lows,” says Dr. Low Wang. “We’re aiming not to let the pendulum swing too far: Not too high, where the patient is experiencing confusion, polyuria, and impaired immunity, and not too low, which can cause problems for the heart and brain, and can even be life threatening.”
Dr. Low Wang encourages anyone caring for a patient in which diabetes is known or suspected to call her team for a consultation (see AMION for the call schedule).
In addition to consults and education, the Glucose Management Team aims to help improve clinical care by identifying quality improvement opportunities. Currently, the team is working on an initiative to decrease hypoglycemia. The team assesses unit reports of hypoglycemia to identify potential areas for intervention and identifying processes to reduce repeated hypoglycemia.
Dr. Low Wang has been in this role for less than a year, but she’s already impressed with how well the program has been received.
“I’ve been amazed at how open people are to learning about patient safety as it relates to the care of individuals with diabetes,” says Dr. Low Wang.
The Glucose Management Team works with providers and teams across University of Colorado Hospital. The team is currently creating a system-wide educational initiative and is also working toward the Joint Commission's Certificate of Distinction for Inpatient Diabetes. Contact Dr. Low Wang at Cecilia.LowWang@UCDenver.edu.
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