The benefits of achieving optimal blood glucose levels of ≥4 and <10 mmol/L during hospital stays are well established; however, achieving these targets in a non-intensive-care setting is difficult. Such management is typically performed by ward nurses but only under instruction from diabetes specialist nurses (DSNs) or physicians. In order to overcome this challenge, the N-DIABIT (Nurse-Driven Diabetes In-Hospital Treatment) protocol has been developed in VU University Medical Centre (VUMC, Amsterdam, the Netherlands).
In the protocol, all ward nurses undergo a half-day training course, delivered by a DSN, to learn the practical essentials of inpatient diabetes management. Once approved and certified, they are responsible for measuring blood glucose levels and initiating treatment immediately (without consultation) up to twice per day, according to a prespecified correctional protocol. If follow-up measurements after 15 minutes and 2 hours reveal that glucose targets are not being met, the nurses consult a physician for therapy adjustment. DSNs visit or call the wards daily to answer questions and ensure the protocol is being applied correctly.
In a new study, the N-DIABIT protocol was evaluated in 210 people with diabetes who were admitted to VUMC in the 5 months after the protocol was implemented, compared with 200 admitted in the 5 months before then. There was no significant difference between the two patient groups in terms of mean blood glucose levels, number of consecutive hyperglycaemic episodes, length of hospital stay or incidence of severe hypoglycaemia.
The protocol was adhered to in 81.3% of cases and nurses took adequate responsibility (i.e. rapid-acting insulin was administered, hypoglycaemia was resolved or a physician was consulted) in 59.0% of hypo/hyperglycaemic episodes. Notably, per-protocol analysis of cases in whom N-DIABIT adherence was ≥70% (n=173) showed significant reductions in mean blood glucose levels and the number of consecutive hypo/hyperglycaemic events compared with the control group. Furthermore, faster detection of abnormal blood glucose levels was noted.
The authors conclude that independent diabetes care by trained ward nurses in accordance with the N-DIABIT protocol is feasible, safe and non-inferior to physician-driven care. Nurse-driven care may reduce delays in contacting physicians and relieve the work of DSNs. In addition to the potential improvements in cost-effectiveness, these findings suggest that the protocol may even improve inpatient glycaemic control.
The study can be read in full here.
