Running head: GLYCEMIC CONTROL & PATIENT OUTCOMES

PICO Paper: Glycemic Control and Its Effect on Patient Outcomes

Aaron Phillips
Ferris State University

GLYCEMIC CONTROL & PATIENT OUTCOMES

Abstract
This paper explores the question; in hospitalized adults, how does tight glycemic control
compare to uncontrolled glycaemia, affect inpatient outcomes? I have conducted research by
reviewing numerous amounts of data to determine the effects hyperglycemia has on inpatient
outcomes. I have explored the research data and made recommendations to improve the quality
and safety of patients. In this paper the author has come to the conclusion that much more
information is needed on diabetes and hyperglycemia. Hyperglycemia events lead to poor
patient outcomes. Increased staff development, education, and research are needed to combat the
diabetic disease.

GLYCEMIC CONTROL & PATIENT OUTCOMES

Glycemic Control and Its Effect on Patient Outcomes
It is no secret that diabetic patients have increased health risks compared to non-diabetic
patients. With health care reform looming all around us, Washington DC and our health care
system are looking for answers. Diabetic mellitus costs our health care system roughly 40 billion
dollars a year and is one of the most expensive chronic diseases in the United State (Talley, Hill,
Steadman, and Hess, 2012). According to Johnston and Van Horn (2011), diabetes mellitus
(DM) affects 25.8 million people or 8.3% of the population of the United States, with type 2 DM
composing of 90%-95% of diagnosis. Because of the absorbent costs of health care more
resources and initiatives are being made to develop new policies and protocols than ever before.
One of those initiatives is the change in the treatment of inpatient hyperglycemia (Talley et al.,
2012).

Do hospitalized diabetic patients have worse outcomes than their non-diabetic

counterparts?

What affects does hyperglycemia have on inpatient outcomes? This is the

groundwork for my research paper.

PICO Question
In hospitalized adults, how does tight glycemic control compare to uncontrolled
glycaemia, affect inpatient outcomes? Measuring diabetes and its outcomes can be a difficult
process. Diabetes is often not the primary reason for hospital admission and is often secondary
(Talley et al., 2012). Hospitalization can cause extra stress on the body leading to increase
hyperglycemic events (Johnson et al., 2011). Diabetic patients compared to non-diabetic
patients, have worse outcomes such as higher mortality, increased wound infection, stroke,
respiratory problems, and renal dysfunction. Moreover, longer intensive care unit and hospital
stays, poorer post-operative physical functioning (Ji, Mei, Wang, Feng, Cai, Sun, and Chi, 2010).

GLYCEMIC CONTROL & PATIENT OUTCOMES

All this evidence leads us to believe that controlling hyperglycemia in diabetic patients is a very
important aspect of patient care.
Nurses play a big role in caring for diabetic patients. Monitoring blood sugars, disease
education, nutrition education, and medication administration are just a few things that nurses do
routinely in the care of diabetic patients. According to the ADA (2012) hypoglycemia is defined
as any blood sugar greater than 140 mg/dL. No matter what type of hyperglycemia seen in the
inpatient setting, any patient that exhibits hyperglycemia should receive treatment to prevent
hyperglycemic complications (Talley et al., 2012). It is vital that nurses use professional
communication to share hyperglycemic activity with their health care team in the inpatient
setting. Delayed communication of hyperglycemic events can lead to increased medical
complications and worse patient outcomes (Johnson et al., 2011).
Research Findings
There have been many changes in the treatment of hyperglycemia in inpatient care. Tight
glycemic control has been defined by Talley et al. (2012) as blood glucose levels between 80 to
110 mg/dL, in surgical intensive care units and in critical inpatient settings. According to
Talleys et al. (2012) study, Changes in the treatment of inpatient hyperglycemia: What every
nurse practitioner should know about the 2012 Standards of Care, mortality increases for every
20 mg/dL over 100 mg/dL. This study reviewed many studies where glycemic control outcomes
were evaluated which revealed interesting results. Talley et al., (2012) states in a single-blind
study with an intensive control group (80-110 mg/dL) showed greater cases of hypoglycemia
compared to conventional therapy (140-180 mg/dL). Moreover Talley et al states that there were
no significant differences in mortality or length of stay in the Glucontrol Trial (2012).

GLYCEMIC CONTROL & PATIENT OUTCOMES

Even though the Glucotrol Study states that there is no increase of length of stay,
hyperglycemia does increase wound infection (Talley et al., 2012). The hyperglycemic state
unfortunately alters leukocyte functions by impairing phagocytosis and hinders that ability to kill
bacteria (Talley et al., 2012). In Qiangs et al. (2010) study, Impact of diabetic mellitus on
patients over 70 years of age undergoing coronary artery bypass grafting, indicates that there is
a much greater risk of infection and hyperglycemia. This study used a quantitative research
method that used a systematic review of data to analyze infection rates of post-operative patients.
Qiangs et al. study sampled 1090 patient over 5 years at a single hospital. Measurements were
done via chart review of glycemic control using blood sugar machines, lab values, infection rate
statistic, and many other values. The study showed that glycemic control is important in
reductions of post-operative infection (Qiang et al., 2012).
In Johnstons et al. study they studied the effects of corrective insulin and basal insulin on
inpatient glycemic control (2011). This study tracked 45 patients blood sugar levels over three
days. The data showed a correlation between the relevance of hyperglycemia and the
complications associated with hyperglycemia (Johnston et al., 2011). An important note to this
study is that the results showed that over half of all the capillary blood glucoses were
hyperglycemic (Johnston et al., 2011). A limitation of this study is of course the sample size.
Recommendations to Improve Quality and Safety
Tracking diabetic complications can be a difficult process. The one thing that studies do
show is that hyperglycemia does contribute on increased infection and other medical
complications (Qiang et al., 2012). Many studies also conclude nurses and physicians are
hesitant in administering insulin to maintain tight glycemic control in the fear of hypoglycemic
events (Johnston et al., 2011). Glycemic control is a hot topic in hospital all around the country.

GLYCEMIC CONTROL & PATIENT OUTCOMES

More studies need to conduct short-term effects and long term effects of hyperglycemia in the
hospital setting. There are so many limitations in the studies that the author has found.
According to Talley et al, (2012) studies related to diabetes are difficult because of many
variables associated with diabetes.
There are many implications for nursing to improve the quality and safety of our diabetic
patients. Nurses must communicate affectively and in a timely manner with physicians to obtain
insulin orders. The author has observed first hand that nurses are hesitant to report
hyperglycemic event patterns and failed to contact the physician in a timely manner. According
to Johnston et al., (2011) nurses and nurse educators could improve glycemic control in hospitals
with education on carb counting. Many nurses and doctors do not feel confident in carb counting
and dosing prandial insulin (Johnston et al., 2011). Continued staff development and education
is needed so that timely and appropriate nursing decisions can be made by staff when caring for
diabetic patients.
Conclusion
Diabetes is a chronic problem that is not going to go away. Todays population continues
to become more obese and diabetes is growing at an alarming rate (ADA, 2012). There is no
single answer that is going to solve this problem. It is apparent that more research is needed and
that nursing is going to have to play a major role in this research if we are ever going to gain
ground on controlling diabetes and the poor outcomes related to hyperglycemia. Studies show
that hyperglycemia has negative effects on patient outcomes (Talley et al., 2012). Diabetes has
many variables and only more measured data, improved collaboration, communication, and
improved technology is going to help fight this disease.

GLYCEMIC CONTROL & PATIENT OUTCOMES

References
American Diabetic Association. (2012). Standards of Medical Care in Diabetes. Diabetes Care,
35(1), S11-S61.
Ji, Q., Mei, Y., Wang, X., Feng, J., Cai, J., Sun, Y., & Chi, L. (2010). Impact of diabetes mellitus
on patients over 70 years of age undergoing coronary artery bypass grafting. Heart &
Lung, 39(5), 404-409. doi:10.1016/j.hrtlng.2009.10.003
Johnston, J. A., & R. Van Horn. (2011). The Effects of Correction Insulin and Basal Insulin on
Inpatient Glycemic Control. MEDSURG Nursing, 20(4), 187-193.
Talley, M. H., Hill, A., Steadman, L., & Hess, M. (2012). Changes in the treatment of inpatient
hyperglycemia: What every nurse practitioner should know about the 2012 Standards of
Care. Journal of The American Academy of Nurse Practitioners, 24(12), 683-689.
doi:10.1111/j.1745-7599.2012.00770.x