ArticleBMJ open diabetes research & care2021
Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes.
Article in BMJ open diabetes research & care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022Guideline
- Effects of a Digital Decision Support System on Diabetes Management in a Real-World Home Care Setting: Prospective Quasi-Experimental Feasibility and Implementation Study.JMIR nursing · 2026Article
- Leveraging human-centered AI for clinical decision-making: a transparent, accurate rule extractor using non-dominated sorting genetic algorithm.BMC medical informatics and decision making · 2026Article
- Article
- The prognostic role of glycemic variability in predicting the risk of adverse cardiovascular events in patients with cardiovascular diseases: a meta-analysis.Diabetology & metabolic syndrome · 2025Review
- Development of insulin and its pharmacology and perioperative use: a narrative review.British journal of anaesthesia · 2025Review
- Developing and Evaluating SEE-Diabetes: A Patient-Centered Educational Decision Support System for Diabetes Care.Journal of evaluation in clinical practice · 2025Article
- Article
- Technology in the management of diabetes in hospitalised adults.Diabetologia · 2024Review
- Applications of Clinical Decision Support Systems in Diabetes Care: Scoping Review.Journal of medical Internet research · 2023Article
- Guardians For Health: A Practical Approach to Improving Quality of Life and Longevity in People with Type 2 Diabetes.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2023Review
- How Can Point-of-Care Technologies Support In-Hospital Diabetes Care?Journal of diabetes science and technology · 2023Article
- Day-to-day fasting plasma glucose variability on the short-term prognosis of ST-segment elevation myocardial infarction: A retrospective cohort study.Clinical cardiology · 2022Article
- Clinical Decision Support for Glycemic Management Reduces Hospital Length of Stay.Diabetes care · 2022Article
- Electronic Health Record-Based Decision-Making Support in Inpatient Diabetes Management.Current diabetes reports · 2022Review
- Use of a Continuous Glucose Monitoring System in High-Risk Hospitalized Noncritically Ill Patients With Diabetes After Cardiac Surgery and During Their Transition of Care From the Intensive Care Unit During COVID-19: A Pilot Study.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022Article
- Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care.Scientific reports · 2021Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
introductionInnovative approaches are needed to design robust clinical decision support (CDS) to optimize hospital glycemic management. We piloted an electronic medical record (EMR), evidence-based algorithmic CDS tool in an academic center to alert clinicians in real time about gaps in care related to inpatient glucose control and insulin utilization, and to provide management recommendations. RESEARCH DESIGN AND
methodsThe tool was designed to identify clinical situations in need for action: (1) severe or recurrent hyperglycemia in patients with diabetes: blood glucose (BG) ≥13.88 mmol/L (250 mg/dL) at least once or BG ≥10.0 mmol/L (180 mg/dL) at least twice, respectively; (2) recurrent hyperglycemia in patients with stress hyperglycemia: BG ≥10.0 mmol/L (180 mg/dL) at least twice; (3) impending or established hypoglycemia: BG 3.9-4.4 mmol/L (70-80 mg/dL) or ≤3.9 mmol/L (70 mg/dL); and (4) inappropriate sliding scale insulin (SSI) monotherapy in recurrent hyperglycemia, or anytime in patients with type 1 diabetes. The EMR CDS was active (ON) for 6 months for all adult hospital patients and inactive (OFF) for 6 months. We prospectively identified and compared gaps in care between ON and OFF periods.
resultsWhen active, the hospital CDS tool significantly reduced events of recurrent hyperglycemia in patients with type 1 and type 2 diabetes (3342 vs 3701, OR=0.88, p=0.050) and in patients with stress hyperglycemia (288 vs 506, OR=0.60, p<0.001). Hypoglycemia or impending hypoglycemia (1548 vs 1349, OR=1.15, p=0.050) were unrelated to the CDS tool on subsequent analysis. Inappropriate use of SSI monotherapy in type 1 diabetes (10 vs 22, OR=0.36, p=0.073), inappropriate use of SSI monotherapy in type 2 diabetes (2519 vs 2748, OR=0.97, p=0.632), and in stress hyperglycemia subjects (1617 vs 1488, OR=1.30, p<0.001) were recognized.
conclusionEMR CDS was successful in reducing hyperglycemic events among hospitalized patients with dysglycemia and diabetes, and inappropriate insulin use in patients with type 1 diabetes.
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