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Hospital hyperglycemia: Status Investigation and Effect of a Real-time Glycemic Alert System

BACKGROUND Hospital hyperglycemia is common and associated with
potential adverse outcomes. A Hospital-wide Mobile Phone Alert (HMA)
system was built to achieve real time glucose monitoring with warnings
for glucose excursions. This study investigated the status of glucose
control and evaluated the impact of HMA system on inpatient glycemia
management. METHODS Inpatients with hyperglycemia hospitalized between 1
January, 2017 and 31 December, 2018 were identified excluding those
< 18 years of age. The HMA system was activated on 1 October,
2017. It sent real time cellphone warning messages to the patient’s
designated team physician whenever glucose levels > 10
mmol/L or < 3 mmol/L were detected. A serum glucose
> 7.8 mmol/L was defined as hospital hyperglycemia (HH),
and > 10 mmol/L was defined as significant HH (SHH).
Glucose excursions before and after the HMA system was instituted were
compared. RESULTS The incidence of HH, SHH and hypoglycemia was 26.1%,
12.8% and 2.5%, respectively. With the HMA system, the monthly glucose
related consultation rate for all inpatients increased 65.9%. The rate
of HH glucose amount/ total glucose amount improved with the HMA system,
being lower than pre HMA system activation for the surgical wards (15.8
± 4.7% vs 21.1 ± 6.1%，p<0.05). CONCLUSIONS In this study,
one third of inpatients were noted to experience hyperglycemia. Real
time cellphone warning messages to the patient’s designated team
physician can improve consultation utilization for blood glucose
excursions. The alert system was found to reduce the incidence of
hyperglycemia on surgical wards.