• Robert J Rushakoff, Mary M Sullivan, Heidemarie Windham MacMaster, Arti D Shah, Alvin Rajkomar, David V Glidden, and Michael A Kohn.
• From University of California, San Francisco, San Francisco, California.
• Ann. Intern. Med. 2017 May 2; 166 (9): 621-627.

BackgroundInpatient hyperglycemia is common and is linked to adverse patient outcomes. New methods to improve glycemic control are needed.ObjectiveTo determine whether a virtual glucose management service (vGMS) is associated with improved inpatient glycemic control.DesignCross-sectional analyses of three 12-month periods (pre-vGMS, transition, and vGMS) between 1 June 2012 and 31 May 2015.Setting3 University of California, San Francisco, hospitals.PatientsAll nonobstetric adult inpatients who underwent point-of-care glucose testing.InterventionHospitalized adult patients with 2 or more glucose values of 12.5 mmol/L or greater (≥225 mg/dL) (hyperglycemic) and/or a glucose level less than 3.9 mmol/L (<70 mg/dL) (hypoglycemic) in the previous 24 hours were identified using a daily glucose report. Based on review of the insulin/glucose chart in the electronic medical record, recommendations for insulin changes were entered in a vGMS note, which could be seen by all clinicians.MeasurementsProportion of patient-days classified as hyperglycemic, hypoglycemic, and at-goal (all measurements ≥3.9 and ≤10 mmol/L [≥70 and ≤180 mg/dL] during the pre-vGMS, transition, and vGMS periods).ResultsThe proportion of hyperglycemic patients decreased by 39%, from 6.6 per 100 patient-days in the pre-vGMS period to 4.0 per 100 patient-days in the vGMS period (difference, -2.5 [95% CI, -2.7 to -2.4]). The hypoglycemic proportion in the vGMS period was 36% lower than in the pre-vGMS period (difference, -0.28 [CI, -0.35 to -0.22]). Forty severe hypoglycemic events (<2.2 mmol/L [<40 mg/dL]) occurred during the pre-vGMS period compared with 15 during the vGMS period.LimitationInformation was not collected on patients' concurrent illnesses and treatment or physicians' responses to the vGMS notes.ConclusionImplementation of the vGMS was associated with decreases in hyperglycemia and hypoglycemia.Primary Funding SourceNational Institutes of Health, the Wilsey Family Foundation, and the UCSF Clinical & Translational Science Institute.

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