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Grant to improve inpatient diabetes care within UMass Memorial hospitals awarded by Diabetes Center of Excellence

Date Posted: Wednesday, June 05, 2019

The second annual Herman G. Berkman Diabetes Clinical Innovation Fund grant has been awarded to Leslie J. Domalik, MD and co-investigator Asem Ali, MD.  The project aims to improve blood glucose control for all patients admitted to the UMass Memorial hospital system who are living with diabetes.

It was developed on the premise that adopting a flexible meal dosing option based on carbohydrate counting would improve the outcomes of hospitalized patients.  The study will focus on coordinating appropriate timing of blood glucose testing, insulin dosing, and when rapid acting mealtime insulin is administered.  It will also provide carbohydrate counts for all food within the hospitals and better coordinate insulin delivery with when meals are delivered to patients.

One third of hospital patients in the U.S. have diabetes or hyperglycemia, and it’s greater than 40% within the UMass Memorial hospitals.  Our Blood Glucose Management Service has revolutionized inpatient diabetes care and decreased the length of hospital stays for people living with diabetes by 25%.  In addition to better patient outcomes, it has resulted in a multi-million dollars revenue increase.  This was accomplished by the UMass Diabetes Center of Excellence expanding care for all hospitalized individuals admitted with diabetes and providing training for all inpatient staff on diabetes related issues.

“Still, nursing work flow limitations has not allowed for coordination of meal delivery with insulin administration, consistent carbohydrate labeling of the food available to patients, and carb counting prior to meals, said Domalik.” 

This grant will support the initial efforts of Dr. Domalik and the UMass Diabetes Center of Excellence’s adult inpatient team to determine the value of these types of services to our patients living with diabetes. 

“We’ve identified inpatient rapid acting insulin dosing as a major area for improvement to better impact patient outcomes,” she added. 

The length of time between blood testing, meal delivery, and insulin administration have been inconsistent.  Meal sizes also vary among hospitalized patients.  Dr. Domalik expects to see even better patient outcomes and shorter lengths of stay as result of this project.

The Berkman Fund was established by UMass Memorial Health Care and the UMass Diabetes Center of Excellence, to support the development of diabetes clinical care initiatives that would not normally find funding through traditional operational expenses or research grants.  Herman Gerald Berkman, PhD, believed greatly in the mission and care model of the UMass Diabetes Center of Excellence.  His estate provides ongoing support through this fund as result of his appreciation of our commitment to high quality and innovation. 

Last year’s inaugural grant was awarded to Daniel J. Amante PhD, MPH and Adarsha Bajracharya, MD.  Their Berkman sponsored project ‘Identifying Diabetes Patients and Leveraging Underutilized Services to improve Care’ (ID PLUS Care) focused on a multidisciplinary, collaborative approach to improve care access, quality, and management for at-risk patients with diabetes.  Their program monitors Electronic Health Record data to identify UMass Medicare Accountable Care Organization patients at risk for negative outcomes and proactively contacts patients to nudge them towards recommended services.

Dr. Bajracharya (middle)      Dr. Amante (right)

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).  It builds upon the Berkman funded ID PLUS Care by developing tailored approaches to increase patient engagement with diabetes self-management training and using technologies to improve patient outcomes.  It will also strengthen the growing collaboration between the Diabetes Center of Excellence, the Department of Population and Quantitative Health Sciences and the Office of Clinical Integration.

This year’s project by Drs. Domalik and Ali aims to serve as the basis for larger prospective, multi-center studies to establish guidelines for the safest and most cost-effective method of delivering rapid acting mealtime insulin.  The American Diabetes Association has published inpatient diabetes care standards which address in-hospital blood glucose monitoring, target levels and treatment options for specific inpatient situations.  However, standard guidelines and methods explaining how to achieve those goals do not yet exist.

During this 12-month project, all hospitalized patients with diabetes will be taught basic carbohydrate counting and asked to track their carb intake at the bedside.  That data will be collected and recorded daily.  The study will also investigate means for effective communication between dietary services and nursing to better coordinate meal delivery and mealtime insulin delivery.

“Collaboration with dietary services will provide patients and staff with accurate written carbohydrate counts for all menu and nourishment center items within our hospitals,” said Domalik. 

She is confident that this pilot study will continue to improve the glucose control of all inpatients within the UMass Memorial hospital system.  In addition, she hopes to provide a blueprint for consistency of optimal inpatient diabetes care.

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