827-P: Pioneering a Novel Inpatient Diabetes Consult Service in the COVID Era

Hospitalized patients often do not reach the ADA-recommended glucose targets, which in turn increases complications, costs, length of stay, and readmission rate. The ADA supports the availability of trained specialists and teams to improve outcomes. Partly in response to the SARS CoV-2 pandemic, we instituted an inpatient “virtual care” initiative by electronic medical record (EMR) review. The ProActive Glucose Advice Team (pGAT) utilizes specialist expertise, automated computerized detection of hyperglycemia, and feedback to the primary service. The pGAT team members consist of an endocrinologist, a nurse diabetes care and education specialist, and a clinical dietician. The team reviewed a computer-generated report of inpatients with either 2 or more blood glucose values ≥180 mg/dl within the last 24 hours, and/or a hemoglobin A1c (A1c) ≥8%. We proposed to enter a brief, structured “pGAT Note” in the EMR, followed by a “gentle reminder” note the next day, including advice for a formal diabetes education and an endocrinology consultation. This proactive approach to the management of hyperglycemia would provide a summary review of the patient’s glucose state, determine the level of patient’s self-care skills, and steps to improve inpatient glycemic control. For preliminary data during the first 4-month phase after implementation of the pGAT initiative, we examined individualized discharge management and timely outpatient follow-up with endocrinology. Of 37 patients (28 males, 9 females; average age 60.4 years), 34 were treated with intensive insulin therapy with multiple daily insulin injections, 31 were seen in f/u within 2 weeks of discharge, and 25 were begun on Continuous Glucose Monitoring. The average A1c fell from an inpatient value of 11.6% to 8.4% measured between 2-4 months later. During the next pGAT phase, we intend to study inpatient therapy parameters, notably appropriate use of computerized insulin order sets, titration of basal insulin, and prandial-correction bolus insulin use.