Spectrum Health Improves Patient Treatment for Diabetes

Spectrum Health has introduced a new evidence based glycemic control treatment approach that is improving the safety and effectiveness of care received by hospital patients.

Twenty-three percent of the 58,000 adult patients admitted to Spectrum Health Butterworth and Blodgett hospitals each year for numerous health concerns also have a secondary diagnosis of diabetes. For every two known patients with diabetes who are admitted, there is an additional patient with high blood glucose who is unaware there is a problem.

Since 2007, Spectrum Health has been examining and implementing clinical research that demonstrates that effective inpatient glycemic control can contribute to reducing health complications, length of hospital stay and patient readmissions.

“It became obvious that the way that we monitored our patients for insulin during their hospital stay could greatly impact the effectiveness of treatment, no matter why they were admitted,” said David L. Dull, MD, vice president, quality, Spectrum Health Grand Rapids. “We realized that any change in glycemic management within the hospital would have to involve a comprehensive hospital wide approach and would require each discipline as well as multiple departments planning and working together.”

Most hospitals in the United States currently treat diabetic patients’ with the use of an insulin dosing method called sliding scale. These patients are administered insulin every four to six hours regardless of what they may have eaten and even though food consumed impacts blood glucose level.

“Patients’ blood glucose levels would spike and recede throughout the day, yet we would respond based on the clock, not their individual blood glucose levels,” explained Greg Deines, DO, medical director, diabetes services, Spectrum Health. “Sliding scale insulin guarantees high blood sugar because we wait for that to happen before we give the patient insulin.”

Since October 1, 2008, Butterworth and Blodgett hospitals no longer accept sliding scale insulin orders (prescriptions) from physicians. Medical evidence has demonstrated that basal bolus insulin dosing is the most effective means of administering insulin.

Basal bolus insulin dosing keeps patient blood glucose in a safe and acceptable range by better simulating how a healthy pancreas works to control insulin levels. Basal insulin is a long acting insulin that lasts up to 24 hours. Bolus insulin is short acting and administration is timed to correspond with what patients’ blood sugar is before they start eating. When the two complementing insulins are combined, the patient experiences better glycemic management as well as minimized complications.

“Our new basal bolus insulin dosing requires calculating and administering the correct dose of insulin given at the correct time. I like to tell medical residents that they need to start thinking like a pancreas,” said Deines, who spends much of his time answering questions and educating physicians, nurses and other staff on the importance of this change.

This new method of treating and monitoring blood glucose has impacted many patients throughout the community. Since physicians often have hospital privileges with more than one health care system, they carry what they have learned at Spectrum Health about basal bolus insulin dosing to their patients at other facilities.

In November, Spectrum Health worked with other local health care systems to establish the West Michigan Hospital Diabetes-Glycemic Management Collaborative to improve, measure and promote evidence based practices for inpatient treatment. Medical and clinical representatives from each of the hospitals-Spectrum Health, Metro Health Hospital and Saint Mary’s Health Care-meet regularly to jointly develop plans to improve treatment for diabetic and non-diabetic patients experiencing hyperglycemia (high blood glucose levels) related to acute illness.

Over 24 million Americans currently suffer from diabetes, the seventh leading cause of death in the United States. According to the American Association of Diabetes Educators, poorly controlled diabetes is also the leading cause of adult blindness, end stage renal disease and non-traumatic lower limb amputations.

Spectrum Health is a not-for-profit health system in West Michigan that offers a full continuum of care through the Spectrum Health Hospital Group, a collection of seven hospitals and more than 140 service sites; the Spectrum Health Medical Group, a multispecialty team of nearly 100 providers; and Priority Health, a health plan with nearly 500,000 members. Spectrum Health’s 14,000 employees, 1,500 medical staff members and 2,000 volunteers are committed to delivering the highest quality care to those in medical need.’ The organization provided $111.1 million in community benefit during its 2008 fiscal year. As a system, Spectrum Health has earned more than 100 awards during the past 10 years.