By Angela Mounsey, BSN, RN, CCM, CPHQ
Diabetes: November 2024 is National Diabetes Month, and November 14th is Diabetes Awareness Day. The theme for the day is “Diabetes and Well-Being”. This day is to raise awareness about Diabetes and to advocate for better care, support for everyone affected by the disease, and prevention of this disease.
The Centers for Medicare and Medicaid Services (CMS) now has Electronic Clinical Quality Measures (eCQMs) for both Hypoglycemia and Hyperglycemia, which was mandated as of 2024, and they are collecting data. CMS still needs to set goals to meet this measure. However, they expect hospitals to set their own targets. Each measure has its own definition.
Severe Hypoglycemia is defined as an Inpatient who is 18 years or older who received at least one Hypoglycemic medication and suffered harm from the severe Hypoglycemia during their hospital stay. Severe Hypoglycemia is a glucose less than 40 mg/dl, and the patient received a hypoglycemic medication 24 hours before the start of the low glucose. Our hospital has set a goal of less than 3% for Severe Hypoglycemia.
Severe Hyperglycemia is defined as an inpatient who is 18 years or older and has had a severe hyperglycemic event (harm) during the hospital stay. Severe Hyperglycemia is defined as a glucose greater than 300 or a glucose greater than 200 at least two or more times a day or two consecutive days greater than 200. Our hospital has set a goal of less than 10% for Hyperglycemia.
These are essential measures and excellent patient safety indicators to protect our patients from harm. We know that we have patients who are admitted to our hospital with either Hypoglycemia or Hyperglycemia. The goal is to get the patient stabilized within a specific period, as indicated in the measures. We currently have a multidisciplinary team to monitor these quality measures and data. Also, the data is being reported to our Quality Improvement team, which meets monthly and then reports to our Quality and Patient Safety Committee and our Board of Directors.
Diabetes Mellitus is a group of diseases that affects how our body uses blood glucose (sugar), a energy source for our muscles, tissues, and brain. Our bodies produce insulin to be used, and that insulin lowers the amount of sugar in the bloodstream.
Causes of Diabetes vary depending on the type you are diagnosed with. Generally, there is Type 1 and Type 2. Others include prediabetes and gestational Diabetes. Type 1 Diabetes can start at any age but often starts in childhood or teen years. I work with a Nurse who was diagnosed in her 30’s. Type 2 Diabetes is the more common and can develop at any age. Mostly Type 2 Diabetes is more common in people older than 40, but Type 2 Diabetes in children is ever increasing. The exact cause of Diabetes for a lot of cases is unknown. Some causes may be genetics or environmental factors, and those risk factors are unclear.
Symptoms Include: excessive thirst; urinating often; losing weight without trying; ketones in urine (Ketones are a byproduct when our muscles and fat breakdown when an inadequate amount of insulin is not available); feeling tired and weak; irritability; mood changes; blurry vision; slow-healing sores; infections of the gums, skin or vaginal infections.
Complications from Diabetes are dependent upon how long you have had Diabetes and if you control your blood glucose. These complications may be disabling or even life-threatening and include Cardiovascular Disease, Diabetic Neuropathy, Kidney Disease, Diabetic Retinopathy, Foot Damage, Skin and Mouth Conditions, Hearing Impairment, Alzheimer’s Disease, and Depression related to long-term disease. Gestational Diabetes - complications for the infant; Excess Growth; Low Blood Sugar, Type 2 Diabetes later in life – Not sure what this means; Death; Preeclampsia during pregnancy.
Prevention includes:
- Eating healthy foods.
- Engaging in physical activity.
- Losing excess weight.
- Living a healthy lifestyle choice.
These are your best prevention options. Unfortunately, Type 1 Diabetes can’t be prevented. The prevention measures listed are also ways to help manage all types of Diabetes once diagnosed.
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Bio: Angela Mounsey works at Marion Health which is a Rural Hospital in Marion Indiana. She is the Manager of Quality Improvement/Care Continuum Department. She works with Quality staff, Clinical Documentation Specialists, Case Managers, Social Workers, and Discharge Planners and continues to work with patients/families on difficult cases. She is a member of Case Management Society of America and a Certified CCM, Certification in Health Quality and have my CPHQ.