Diabetes is the sixth leading cause of death in the U.S. and having diabetes can also increase a person's risk sudden cardiac death by two to four times. Left untreated, diabetes can also lead to kidney failure, blindness and a condition called diabetic neuropathy, which leads to foot ulcers.
That’s why education for patients and disease management is so important. All Akron General Medical Center nurses are trained to manage blood sugar levels for patients.
Compare Akron General with National Standards in Diabetes Care:
Certified Diabetes Educator on Staff
Diabetes Education Program
Diabetes Education Program Recognition by ADA Education Recognition Program
Diabetes Education/Training Requirement for Staff Nurses
Availability of Diabetes Physician Specialists
Physician Recognition Program
Screening and Treatment of Hyperglycemia
Treatment of Hyperglycemia in Critically Ill
Prevention and Treatment of Hypoglycemia Protocol
Bedside Glucose Monitoring
Discharge Planning
1. Certified Diabetes Educator on Staff
The purpose of the National Certification Board for Diabetes Educators (NCBDE) certification program is to conduct certification activities in a manner that upholds standards for competent practice in diabetes education. The Certified Diabetes Educator (CDE®) credential demonstrates that the certified health care professional possesses distinct and specialized knowledge, thereby promoting quality care for persons with diabetes.
Certification is a voluntary testing program used to assess and validate qualified health care professionals' knowledge in diabetes education. It is an evaluative process that demonstrates that rigorous eligibility requirements have been met. (National Certification Board for Diabetes Educators)
Diabetes self-management training, also called diabetes education, gives patients the knowledge and skills to be able to effectively manage their diabetes on a daily basis. Through a collaborative process, diabetes educators help their patients identify barriers, facilitate problem solving and develop coping strategies. (American Association of Diabetes Educators)
Akron General Medical Center has a Certified Diabetes Educator on staff to help ensure the highest levels of care for diabetic patients.
2. Diabetes Education Program
Diabetes self-management training, also called diabetes education, gives patients the knowledge and skills to be able to effectively manage their diabetes on a daily basis. Self-management of diabetes is of utmost importance in achieving better health and independence in lifestyle choices. Through a collaborative process, diabetes educators help their patients identify barriers, facilitate problem solving, and develop coping strategies. (American Association of Diabetes Educators)
Studies have shown that diabetic patient outcomes are improved by patient teaching. Care of diabetic patients is improved, and the length of hospital stays may be reduced by as much as 28 percent. (Journal of Nursing Staff Development, March/April 1997: 13(2); 93-98)
Akron General Medical Center offers a Diabetes Education Program to assist diabetic patients in the optimal self-management of their disease process.
3. Diabetes Education Program Recognition by ADA Educational Recognition Program
In order to be recognized by the American Diabetes Association’s Education Recognition Program, the structure, process, and outcomes of the diabetes education services must include:
1. one sponsoring organization and a qualified coordinator
2. an advisory system that annually plans and evaluates the services offered, and reviews the participants' outcomes
3. instructional team that include at least a registered dietitian (RD) and a registered nurse (RN) who have continuing education and experience in both diabetes and behavioral teaching/counseling skills
4. instructional staff that include at least two health care professionals from at least two different health care disciplines who have continuing education and experience in both diabetes and behavioral teaching/counseling skills
5. a written curriculum with measurable learning objectives based on the National Standards 10 content areas
6. participant education records that document individualized assessment related to the National Standards content areas, education plan with learning and behavioral objectives, interventions, evaluations, and team collaboration
7. tracking of participants' behavioral and other outcomes as part of a continuous quality improvement (CQI) process to evaluate the effectiveness of the diabetes education services (American Diabetes Association Education Recognition Program)
4. Diabetes Education/Training Requirement for Staff Nurses
As a result of the increasing incidence of diabetes in the US, diabetes has become one of the main causes of hospitalization in the US. One of the most crucial factors in diabetes control is patient education. Nurses are the largest group of healthcare professionals with prolonged contact with the diabetic patient, thus nurses play an important role in diabetes education. (Journal for Nurses in Staff Development, January/February 2001: 17(1); 5-11)
Several studies have shown that hospital staff nurses often lack a complete knowledge base of diabetes. Improving nurses’ knowledge of diabetes is an important first action to improve the effectiveness of diabetes patient education. (Journal for Nurses in Staff Development, November/December 2002: 18(6); 297-303)
Studies have shown that diabetic patient outcomes are improved by patient teaching. Care of diabetic patients is improved, and the length of hospital stays may be reduced by as much as 28 percent. (Journal of Nursing Staff Development, March/April 1997: 13(2); 93-98)
Akron General Medical Center requires attendance at diabetes-related educational programs by all staff nurses. Programs include glucometer testing, unit inservices and core curriculum offerings.
5. Availability of Diabetes Physician Specialists
Studies have consistently shown that specialist care is associated with better outcomes and better delivery of processes of care than by generalists. (Disease Management and Health Outcomes, April 2004: 12(4); 229-238)
Studies of patients hospitalized with acute diabetic ketoacidosis (a condition in which blood sugar levels become elevated due to a lack of insulin - the body begins to break down fat and muscle tissue for energy, causing a buildup of wastes in the blood) showed that patients managed by an endocrinologist had shorter lengths of stay than patients managed by a generalist. (Diabetes Care, November 1999: 22(11); 1790-1795)
Akron General Medical Center has diabetes physician specialists available to provide consultant advice for and/or manage the care of diabetic patients.
6. Physician Recognition Program
The National Committee for Quality Assurance’s (NCQA) Diabetes Physician Recognition Program, cosponsored by the American Diabetes Association (ADA), is a voluntary program for individual physicians or physician groups that provide care to people with diabetes. Physicians can achieve recognition by submitting data that demonstrates they are providing quality diabetes care.
Physicians at Akron General Medical Center have been recognized by the National Committee for Quality Assurance’s (NCQA) Program for excellent quality diabetes care to their patients.
7. Screening and Treatment of Hyperglycemia
Hyperglycemia (elevated blood sugar level) is associated with poor outcomes. The definition of hyperglycemia varies. However, The American Diabetes Association Expert Committee on the Diagnosis and Classification of Diabetes Mellitus defines hyperglycemia as a fasting blood glucose greater than or equal to 126 milligrams per deciliter (mg/dl)or a random blood glucose greater than or equal to 200 milligrams per deciliter (mg/dl) occurring during hospitalization.
Hyperglycemia is common in people admitted to hospitals and is easier to treat if detected early. It can result from changes in medications, increased nutrient intake, and physical or emotional stress. Some individuals with hyperglycemia will develop diabetes while others will not.
Historically, high blood glucose in hospitalized persons has been tolerated in part due to fear of causing dangerously low blood glucose from over treating the high glucose levels. Current research indicates that aggressive management using insulin is the safest treatment for most people with hyperglycemia (Diabetes Care, January 2006, 29(1); S4-S42).
Careful hyperglycemia management of hospitalized persons also improves clinical outcomes such as infection and mortality among surgical patients (Diabetes Spectrum. 2005, 18; 20-27).
The American College of Endocrinology (ACE), the American Association of Clinical Endocrinologists (AACE), and other organizations endorse the need for early detection of hyperglycemia and aggressive treatment approaches (Diabetes Care, February, 2004, 27; 553-591).
Akron General Medical Center has established protocols (evidence-based formal plans for managing a disease or condition) for detecting and treating hyperglycemia. Protocols and treatment pathways are established by an integrated multidisciplinary team of physicians, nurses, and pharmacists
8. Treatment of Hyperglycemia in Critically Ill
Hyperglycemia (elevated blood sugar level), often present in critically ill patients, is associated with increased in-hospital morbidity and mortality in many medical and surgical conditions, such as cardiovascular disease, (The Lancet, March 4, 2000: 355(9206); 773-778) stroke (Stroke, October 2001: 32(10); 2426-2432), and cardiac surgery patients. (Circulation, March 30, 2004: 109 (12); 1497-1502; The Annals of Thoracic Surgery, February 1999: 67(2); 352-360)
Several studies have shown that reduction of hyperglycemia in critically ill patients improves outcomes. For example, in the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study, the long-term prognosis in diabetic patients with acute myocardial infarction (AMI) was improved by strict blood sugar management. (Circulation, May 25, 1999: 99(20); 2626-2632)
Studies reported that intravenous insulin therapy to maintain blood glucose levels at or below 110 milligrams per deciliter (mg/dl) reduced complications and in-hospital mortality among critically ill patients in the surgical intensive care unit. (The New England Journal of Medicine, November 8, 2001: 345(19); 1359-1367; Clinical Diabetes, April 2004: 22; 81-88) Continuous insulin infusion was also found to reduce the in-hospital mortality after coronary artery bypass grafting associated with diabetes. (Journal of Thoracic and Cardiovascular Surgery, May 2003: 125(5); 1007-1021)
Other studies found by implementing intensive glucose monitoring and treatment protocols to maintain a targeted blood glucose level lower than 140 milligrams per deciliter (mg/dl) resulted in a decrease in the mortality rate, organ dysfunction, and length of stay in the intensive care unit for critically ill patients. (Mayo Clinic Proceedings, August 2004: 79(8); 992-1000)
At Akron General Medical Center, we have standardized protocols (evidence-based formal plans for managing a disease or condition) for treating hyperglycemia (administration of intensive insulin therapy) in critically ill patients and in certain patients with cardiac, stroke, or other medical conditions to maintain targeted blood glucose levels. Protocols and treatment pathways are established by an integrated multidisciplinary team, including physicians, nurses, and pharmacists.
9. Prevention and Treatment of Hypoglycemia
Hypoglycemia (low blood sugar level) can occur in patients in the hospital due to multiple risk factors, such as a change in the nutritional status and meal time, infection, heart failure, renal or liver disease, malignancy, reduction of corticosteroid dose, reduction of oral intake or NPO (fasting) status, vomiting, interruption of enteral feedings or intravenous nutrition, pre-meal insulin given and meal not eaten, and other factors. (Diabetes Care, January 2005: 28; S4-S36)
At Akron General Medical Center, blood glucose levels are frequently monitored and a plan of care for preventing and treating hypoglycemia (low blood sugar level) is developed for patients requiring monitoring of blood sugar levels. Standardized protocols (evidence-based formal plans for managing a disease or condition) for preventing and treating hypoglycemia have been established by an integrated multidisciplinary team, including physicians, nurses, and pharmacists.
10. Bedside Glucose Monitoring
Bedside glucose monitoring (BGM), a type of Point of Care Testing (POCT), involves laboratory testing performed outside of the clinical laboratory at the patient’s bedside. New trends in healthcare involve laboratory testing for blood sugar at the point where patient care is given. Advanced technology has produced instruments that are easy to operate and can perform high quality tests results at the bedside.
A complete quality assurance program, usually directed by a laboratory professional, is involved in the administration and quality control of the program. (Diabetes Care, February 2004: 27(2); 553-591; American Society for Clinical Laboratory Science, Point of Care Position Paper; College of American Pathologists, (CAP) Laboratory Accreditation Program)
At Akron General Medical Center, we have implemented a comprehensive bedside glucose monitoring quality assurance program to ensure consistent performance and documentation of quality blood sugar testing at the bedside. Our quality assurance program includes: that the quality assurance program is directed by a laboratory professional; qualified and trained personnel perform bedside glucose laboratory testing; laboratory and nursing personnel receive comprehensive training, procedures are established, followed and documented for the maintenance and cleaning of instruments; testing at the point of care meets the same accreditation/regulatory requirements as the central laboratory, such as the College of American Pathologists (CAP) Accreditation Program.
11. Discharge Planning
A discharge plan developed by an interdisciplinary team helps to improve the transition from hospital to home or other facility. Discharge planning should address individual needs. For those with newly diagnosed or uncontrolled diabetes, the plan should include outpatient education and follow up diabetes management appointments (Diabetes Care. January 2006, 29(1): S4-S42).
Trying to teach or learn in a hospital setting can be difficult due to the busy and sometimes stressful environment, but basic "survival skills" for managing diabetes need to be taught prior to discharge. Survival skill training helps to ensure safe self-care once a person with newly diagnosed diabetes goes home. It includes information on medications, diet, exercise, disease process, and insulin administration. Further training and adjustment of medications is needed for optimal diabetes management, but this generally takes place later.
In the outpatient setting, follow-up education builds upon "survival skill" training. Additional training may also help those who have not had recent diabetes education to make improvements.
At Akron General Medical Center, patients with diabetes participate in discharge planning specific to their unique needs. Information on medications, diet, exercise, disease process, insulin administration, and follow up appointments are included in the plan. Persons newly diagnosed with diabetes receive "survival skill" training to ensure a safe transition to the home setting or other facility.
