Adherence of Emergency Physicians to clinical guidelines for hyperglycemia using a specific computing tool (GLIKAL©)

• Main Authors: César Carballo Cardona, Paloma Gallego Rodríguez, Laura W Alba, Miguel Zamorano Serrano, María Jesús Estévez Rueda, Cristina Fernández-Pérez
• Format: Article
• Language: English
• Published: Asociación Para el Progreso de la Biomedicina 2016-06-01
• Series: Jounal of Negative and No Positive Results
• Subjects: Hyperglycemia; diabetes mellitus; Emergency Department; computing tool; GLIKAL
• Online Access: https://www.jonnpr.com/pdf/931.pdf

Goal: to evaluate the adherence of Emergency Physicians to clinical guidelines for medical treatment in in-hospital patients, evaluated by using a specific computing tool (GLIKAL©) in patients with hyperglycemia and/or diabetes mellitus. Methodology: An observational study with descriptive cases was designed, with no intervention, including patients from an urban, tertiary university hospital. Patients pending admittance were recruited, starting at the very first hours of the day, any day of the week. Inclusion criteria were age above 18 years old, with glycaemia >150 mg/dl upon admittance to hospital (with a known diabetes or not) who were admitted to hospital from the Emergency Department. The study period included was from June to October 2012. The independent variables were age, sex, previous treatment for diabetes, type of diet prescribed upon admittance, corticosteroid treatment, serum creatinine and glycaemia upon admittance to the Emergency Department. The outcome variable was the treatment suggested by the software program, which was evaluated with 11 items gathered by the specific computing tool (GLIKAL©). Results: 125 patients were gathered, amongst which eight were discarded due to mistakes in the initial data collected. Of the remaining 117 patients, the mean age was of 78.1 years old, with 61% males. Among these 117 patients, 74 of them (63.4%) were being treated with oral antidiabetic drugs alone or in combination with insulin, of which 13 cases (17.5%) continued having it prescribed by the physician even when it was not suitable, while no mistake was detected in the treatment specified by GLIKAL© (p<0.001). The following percentages of correct prescriptions by the physicians were found: basal insulin treatment adjusted to weight (22.6%), basal treatment adjusted to nil per os diet (0%), treatment adjusted according to newly prescribed treatment with corticosteroids (10%), adjusted to deteriorated kidney function (14.2%) or if the corrective treatment was adjusted to weight (17.9%), in comparison with 100% accomplished by GLIKAL©. The investigators concluded that of the 117 analyzed patients, the treatment suggested by GLIKAL© was correct in all of them, as opposed to 17 (14.52%) of the treatments suggested by the physician, which constitutes a 85.4% of incorrect treatments, with 4 patients in which the treatment was considered “unclear”. Conclusion: the adherence of the physicians from the Emergency Department to the guidelines for treating patients with hyperglycemia or diabetes mellitus, as gathered in the GLIKAL© program, was inadequate.