By Kellie Antinori-Lent, MSN, RN, ACNS-BC, BC-ADM, CDCES, FADCES
The Endocrine Society updated their 2012 practice guideline that focuses on glycemic management in the hospital setting. The article, “Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline,”(1) was published online June 12th (https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgac278/6605637) and will be featured in The Journal of Clinical Endocrinology & Metabolism in August. The goal of the revision was to address and incorporate emerging technology and current research into the new guideline.
Who was involved and how was the guideline created?
The writing committee included 11 content experts including 9 endocrinologists, an internal medicine physician, pharmacist, nurse, patient representative, and 2 clinical practice guideline methodologists. Both the pharmacist and nurse held the BC-ADM credential; the nurse was also a CDCES. I was pleased to be on the writing team, representing diabetes care and education specialists.
The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to development the guideline. Systematic reviews and meta-analyses were conducted on each question. Evidence to decision (EtD) criteria, a key part of the GRADE framework, was used to determine both the certainty of the evidence and strength of each recommendation.
This well-respected approach was new to many of us on the panel, so support and guidance from the research experts was essential. A discussion about this approach is beyond the scope of this blog. To learn more about the guideline development framework see: The GRADE Evidence to Decision (EtD) framework for health system and public health decisions (nih.gov) (2). A systematic review of the evidence was also simultaneously published and can be found here: dgac277 Systematic Review.pdf (3).
How is this important to DCESs and our specialty?
This practice guideline is extremely important for the specialty in many ways.
First, ADCES was invited to the table to be a part of the team. This was not an ADCES initiative, but that of another well-known and respected association in the diabetes care space. The invitation is an acknowledgement of our value and contribution to the diabetes care team.
Secondly, one of the recommendations (recommendation 4.1) focuses exclusively on diabetes education. The evidence revealed that inpatient diabetes education can potentially reduce A1c levels, lower readmission rates and improve patient satisfaction. Considering how few patients receive diabetes education in the out-patient setting, hospitalization becomes an opportunity that must not be missed. The recommendation also acknowledges the importance of having DCESs on staff to provide and oversee this work.
Third, this guideline will have extensive national and international exposure. Getting the word out about the value of our work is critical!
If you work in the hospital setting, you now have another tool in your toolbox to demonstrate the value and impact of the work you do. The guideline has 14 other clinical recommendations I did not even discuss! Print the article, read it, digest it, and share it—do not keep the news to yourself. Keep spreading the word about the value of the work you do!
(1) Mary T Korytkowski, Ranganath Muniyappa, Kellie Antinori-Lent, Amy C Donihi, Andjela T Drincic, Irl B Hirsch, Anton Luger, Marie E McDonnell, M Hassan Murad, Craig Nielsen, Claire Pegg, Robert J Rushakoff, Nancy Santesso, Guillermo E Umpierrez, Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, 2022; dgac278, https://doi.org/10.1210/clinem/dgac278
(2) Moberg J, Oxman AD, Rosenbaum S, Schünemann HJ, Guyatt G, Flottorp S, Glenton C, Lewin S, Morelli A, Rada G, Alonso-Coello P; GRADE Working Group. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst. 2018 May 29;16(1):45. https://doi: 10.1186/s12961-018-0320-2. PMID: 29843743; PMCID: PMC5975536.
(3) Mohamed O. Seisa, Samer Saadi, Tarek Nayfeh, Kalpana Muthusamy, Sahrish H. Shah, Mohammed Firwana, Bashar Hasan, Tabinda Jawaid, Rami Abd-Rabu, Mary T. Korytkowski, Ranganath Muniyappa,, Kellie Antinori-Lent, Amy C. Donihi, Andjela T. Drincic, Anton Luger, Victor D. Torres Roldan, Meritxell Urtecho, Zhen Wang, and M. Hassan Murad.
A systematic review supporting the Endocrine Society clinical practice guideline for the management of hyperglycemia in adults hospitalized for noncritical illness or undergoing elective surgical procedures. The Journal of Clinical Endocrinology & Metabolism, 2022; https://doi.org/10.1210/clinem/dgac277
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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