Herman G. Berkman Diabetes Clinical Innovation Grant Awarded to Improve Inpatient Diabetes Care at UMass Memorial Hospitals
Date Posted: Wednesday, June 05, 2019
The second annual Herman G. Berkman Diabetes Clinical Innovation Fund grant was awarded to endocrinologists Leslie Domalik, MD, and Asem Ali, MD, to improve blood glucose control for all patients with diabetes admitted to UMass Memorial Hospital.
It was developed on the premise that adopting a flexible meal-dosing option based on carbohydrate counting would improve outcomes for hospitalized patients. The study will coordinate the appropriate timing of blood glucose testing, insulin dosing, and the administration of rapid-acting mealtime insulin. It will also provide carbohydrate counts for all food in the hospitals and better coordinate insulin delivery with meal delivery to patients.
One third of hospital patients in the United States have diabetes or hyperglycemia, and it’s greater than 40% within the UMass Memorial hospitals. The Blood Glucose Management Service has decreased the length of stay for people with diabetes by 25%. In addition to improving patient outcomes, it has resulted in a multi-million-dollar increase in revenue. This was accomplished by the UMass Memorial diabetes clinic expanding care for all hospitalized individuals admitted with diabetes and providing training to inpatient staff on diabetes-related issues.
Still, nursing workflow limitations have not allowed for coordination of meal delivery with insulin administration, consistent carbohydrate labeling of available patient food, or carb counting before meals. The timing between blood testing, meal delivery, and insulin administration is inconsistent. Meal sizes also vary among hospitalized patients. Inpatient rapid-acting insulin dosing was identified as a significant area for improvement to better impact patient outcomes.
All hospitalized patients with diabetes are learning basic carbohydrate counting and are asked to track their carb intake at the bedside. This project was designed to improve communication between dietary services and nursing to better coordinate meal and insulin delivery during mealtime.
Additional Berkman Fund Recipients
Developing a Liver Disease Screening Process in the Adult Diabetes Clinic
Liver disease is strongly associated with type 2 diabetes and obesity. It remains underdiagnosed and undertreated, and many people living with T2D are unaware they have it. This project, led by Endocrinologist Madona Azar, MD, implemented a new process in the UMass Memorial diabetes clinic that uses a screening tool to analyze clinically available data to determine patients' risk of liver fibrosis.
AI Diabetic Retinopathy Screening in Primary Care
This project implemented an artificial intelligence (AI)- based diabetic retinopathy screening program in Family Medicine clinics to detect eye disease and improve comprehensive care for people living with diabetes. Recent studies have identified AI-based algorithms as promising tools for screening and early detection of diabetic retinopathy, helping those at risk. This study, led by optometrist Juan Ding, OD, PhD, tested the diagnostic accuracy of a hand-held AI-assisted camera used by primary care physicians to screen at-risk individuals for retinal changes indicative of diabetic retinopathy.
The GOOD-ER Program
This randomized clinical trial provided continuous glucose monitors (CGM) to people with diabetes who were currently not using one and arrived at the Emergency Room with high or low blood sugar, or other diabetes-related complications. The recently completed study, led by endocrinologist Dr. Mark O’Connor and emergency physician Dr. Laurel O'Connor, analyzes whether CGM prevents people from returning to the ER with diabetes-related issues, compared with the control group that does not wear a device to monitor their blood sugar.
Identifying Diabetes Patients and Leveraging Underutilized Services to Improve Care’ (ID PLUS Care)
This project, led by Daniel Amante, PhD, and Adarsha Bajracharya, MD, focused on a multidisciplinary, collaborative approach to improve care access, quality, and management for at-risk patients with diabetes. They monitored Electronic Health Record data to identify UMass Medicare Accountable Care Organization patients at risk for adverse outcomes and proactively contacted patients to encourage them to receive recommended services. It led to Dr. Amante receiving a three-year KL2 Mentored Career Development Training grant to develop a Diabetes Mellitus program using Behavioral economics to Optimize Outreach and Self-management support with Technology (DM-BOOST).