A Multi-Disciplinary Approach to Identification and Treatment of Hyperglycemia on an Inpatient Hematopoietic Stem Cell Transplant (HSCT) Unit

Background/Problem: The incidence of hyperglycemia during and after HSCT has been shown to increase length of stay as well as the risk of neutropenic infections during transplantation. Severe hyperglycemia has been shown to predict the incidence acute graft-versus-host disease.  There is a paucity of literature regarding implementation of a systematic screening and intervention program within HSCT programs to proactively address hyperglycemic events and minimize the potential effects of untreated hyperglycemia. 

Intervention:  A multi-disciplinary “Hyperglycemia Team” reviewed the literature and implemented a comprehensive screening and intervention program.  A hyperglycemic protocol was implemented on the HSCT units in 2012. All patients with at least one serum or capillary blood glucose (BG) greater than 200 mg/dL in the previous 24 hour period were identified via computer-generated reports each morning.  A Certified Diabetes Educator (CDE) then screened each patient's medical record to assess whether the patient was receiving insulin therapy to treat hyperglycemia.  If the patient was not receiving insulin therapy or the therapy was inadequate, the CDE would contact the primary HSCT providers to facilitate implementation or escalation of a hyperglycemic protocol and/or an endocrinology team consultation. 

Results:  All serum and capillary blood glucoses performed on the inpatient stem cell transplant units were analyzed for 12 months prior to (n=14780) and subsequent to (n=15138) our intervention.  The incidence of BG levels > 180 mg/dL significantly decreased by 16% (p=<.0001) while the incidence of hypoglycemic events (BG levels < 60 mg/dL) requiring medical intervention significantly decreased by 42% (p=<.0001) (Figure A).  The number of blood glucose levels at the target goal of 100-180 mg/dL significantly increased by 7.8% (p=<.0001).

Conclusion: A multi-disciplinary approach to the identification and treatment of hyperglycemia is essential to decrease the incidence of hyperglycemia.  We concurrently achieved a significant decrease in BG levels and the incidence of hypoglycemic events requiring medical intervention. 

Serum/Capillary Blood Glucose Levels on HSCT Units-Figure A

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