Electronic records fosters glucose control in diabetics

The use of electronic medical records (EMRs) for insulin order sets can improve glycemic control in hospitalized diabetes patients, researchers said here. The rate of hypoglycemia pre-EMR subcutaneous insulin order sets was 9.6%, which dropped to 3.8% after the adoption of an EMR, according to Karla M. Arce, MD, from the Cleveland Clinic Florida in Weston, Fla., and colleagues. The difference was significant at P=0.03 (95% CI 0.27 to 0.51), Arce said here at the American Association of Clinical Endocrinologists (AACE) meeting. She noted that poor glycemic control in hospitalized patients is associated with worse outcomes. In particular, patients with hypoglycemia tend to have longer hospital stays. Also, patients with sepsis, liver disease, renal insufficiency, bacteremia, and the elderly have a higher mortality rate if they are hypoglycemic. But it's a balancing act to maintain tight glycemic control without inducing hypoglycemia, she said, adding the "benefits outweigh the risks." That's where the EMR comes in. An EMR can ensure accurate tracking of all orders during all phases of hospitalization. This help clinicians avoid duplicate orders or prescribing more than one medication from the same class. In their study, Arce and colleagues retrospectively evaluated a randomly selected number of records of diabetic patients from 2007 to 2011. A total of 34 patients with 730 blood glucose values comprised a pre-EMR group and 222 patients with 2,967 blood glucose values comprised a post-EMR group. Hypoglycemic readings were defined as less than 80 mg/dL, euglycemic as between 80 and 180 mg/dL, and hyperglycemic as greater than 180 mg/dL. The post-EMR group had a significant 6% lower rate of hypoglycemia. Also, the rate of euglycemia was significantly greater in the post-EMR group (65% versus 60%, P