A CMO Guide to Caring for Diabetes Patients in the Hospital Setting

The American Diabetes Association has established standards of care for diabetes patients in the hospital setting.

Three dozen hospitals across the country have been recognized for providing care to diabetes patients based on guidelines established by the American Diabetes Association (ADA).

For diabetes patients in the hospital setting, hyperglycemia, hypoglycemia, and glucose variability have been linked to adverse outcomes, including morbidity and mortality, according to a study published by the Journal of Clinical Endocrinology and Metabolism. The ADA says hospitals that follow their guidelines can improve outcomes, shorten hospital stays, and reduce hospital readmissions and emergency department visits.

"We are following the American Diabetes Association standards of care for diabetes patients," says Harpreet Pall, MD, MBA, CMO of Hackensack Meridian Jersey Shore University Medical Center, which is part of Hackensack Meridian Health. "We are using these standards to address all aspects of diabetes care for our patients. This has been a tremendous benefit for our diabetes patients in the hospital setting."

It is meaningful and important for a hospital CMO to be involved in the standard of care for patients with diabetes, according to Pall. The goal is for admitted patients to have a safe and efficient time in the hospital.

"We also want to make sure that the care that is being delivered to patients is based on evidence," Pall says. "We want to make sure that there is evidence that therapy decreases complications."

The ADA standards are helpful because they give hospital clinical teams a roadmap to follow, Pall explains.

"The care teams know that there is a standard way to approach care that is evidence-based and improves outcomes for patients who are affected by diabetes," Pall says.

The ADA standards of care are essential in the management of hospitalized diabetes patients at Denver Health, according to Rocio Pereira, MD, chief of endocrinology at the health system.

"We regularly review the American Diabetes Association's standards of care to make sure we are following recommendations," Pereira says. "As those standards of care change, we make sure we are keeping up to date with the newest recommendations."

Harpreet Pall, MD, MBA, is CMO of Hackensack Meridian Jersey Shore University Medical Center. Photo courtesy of Hackensack Meridian Health.

Examples of following the ADA guidelines

The ADA standards guide hospitals in managing glucose variability in the hospital setting.

"We provide a lot of education to our providers who are putting in the orders for different medications that can affect patients' insulin sensitivity and glucose level," Pereira says. "For example, we make sure that providers are aware that when they start a patient on a steroid medication, it can increase the patient's glucose level."

Multidisciplinary teams are focused on managing glucose variability among diabetes patients at Hackensack Meridian Jersey Shore University Medical Center, according to Pall.

"Our clinical diabetes advocates, which include diabetes educators, are consistently looking at the reports of patients who are admitted to the hospital," Pall says. "They measure and monitor glucose levels as well as hemoglobin A1C with the endocrinologists as appropriate."

The ADA guidelines call for providing a personalized approach to managing glucose levels that are outside the normal range among diabetes patients, since no two patients are alike.

"Although we have protocols and order sets, we also know that these patients' blood sugar levels are not always going to do what we think they are going to do," Pereira says. "It depends on factors such as their insulin sensitivity and the medications that are being used. So, we make sure that the care teams are trained to know the factors that affect blood sugar."

It is important to involve patients and families in the care that is provided to diabetes patients in the hospital setting, according to Pall.

"The multidisciplinary teams that we have consisting of endocrinologists, diabetes educators, nurses, and dietitians must involve the patient and the family as they discuss options related to their care," Pall says. "That is how we can ensure that our care comes across as being personal and not just a standard cookbook of treatment options."

The ADA guidelines call on hospitals to have structured order sets in their electronic health records that provide guidance for the care of diabetes patients in the inpatient setting.

Denver Health has structured order sets in the health system's EHR, including an order set for managing blood sugar. That order set helps providers know the options for the types of insulin that can be used for a particular patient.

"Having order sets in the EHR makes it much easier for the providers to know what they should order for patients depending on different conditions," Pereira says. "The order sets are great to educate our providers, including residents and fellows."

Having structured order sets in the EHR is crucial for diabetes and its management, according to Pall, especially because the insulin dosages can change depending on a patient's medications.

"The order sets for diabetes care in the hospital are well designed and standardized," Pall says. "We have discharge order sets as well. We have guidelines associated with the order sets, so it is obvious for clinicians who are using these order sets to know the parameters for their use."

Having structured order sets in the EHR is important for care teams to have a standard way to approach diabetes care, Pall explains.

"In the absence of structured order sets, things could get missed or the parameters for certain therapies could be variable," Pall says. "It is important to keep care consistent, so we are giving the right treatment to the right patient."

The ADA guidelines call on hospitals to have specialized care teams for their patients who have diabetes.

"Clinical diabetes advocates are a cornerstone of our specialized diabetes care team," Pall says. "They partner effectively with our endocrinologists, nurses, patient experience liaisons, case managers, and dietitians."

Having a specialized care team for hospital patients with diabetes boosts the quality of care and improves outcomes, Pall explains.

"Diabetes is a complex condition," Pall says. "These patients have multiple medical, social, and dietary needs. Having a team to address all aspects of a patient's care—not just the medical aspect—is important. We want to provide care that is personalized and geared toward the needs of the patient."