Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 24

24 - CHALLENGES IN MANAGING DIABETES IN PERSONS WITH END-STAGE RENAL DISEASE ON HEMODIALYSIS IN THE INPATIENT SETTING- INITIAL RESULTS FROM A QUALITY IMPROVEMENT STUDY

Friday, Apr 26
11:30 AM – 12:00 PM

Objective :

Diabetes is challenging to manage in the inpatient settings due to a myriad of reasons. End-stage renal disease (ESRD) adds a significant degree of complexity that requires further study. Intercurrent illness and hospitalization impact the glucose fluctuations already inherent in ESRD. It is well known that poor glycemic control during hospitalization causes significant morbidity and mortality. These challenges were evident in inpatient diabetes rounds at our teaching hospital, especially on days patients were not receiving hemodialysis (HD).


Methods :

We designed a quality improvement study to understand the impact of HD on glycemic control and improve glycemic control in a hospitalized setting and ESRD.


Goal:



  1. Determine the impact of HD on glycemic control. Process: Chart review.

  2. Make changes based on above findings, to insulin dosing and increase percentage of glucose in range by 20% in this group by December 2019. Process: Plan-Do-Study-Act.


Measures:


Glycemic control on HD day and post HD day (percentages of hypoglycemia, hyperglycemia and glucose in range). Insulin use (basal-bolus and correction doses), concomitant systemic steroid, antibiotic use, nutritional intake status, and patient demographics.


Results :

On average patients had 6.3 glucose readings per day. We compared pre-meal sugars between the two groups. Glucose in range (64.1 vs. 27.2%) and hyperglycemia (12.8 vs. 30.5%) were both better on HD days compared to non HD days. The hypoglycemic episodes were similar (20.5 vs.16.7%).


 


 


Discussion :

On our initial chart review we found that persons with ESRD had better glycemic control on days they received HD unlike the days they were not dialyzed. Further study and analyses will reveal what contributes to this difference if in fact it exists on a larger review. It would also be interesting to see if in fact HD causes improved glycemic control. This would lead to optimization of insulin dosing for HD and non HD days.


 


Conclusion :

Glycemic variability is a high-priority problem especially in the high-risk group- persons with ESRD. Ongoing investigation and focused intervention can greatly improve the outcomes in this group.

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Amanda N. Cantu

Endocrinology Fellow, PGY-4
Texas Tech University Health Sciences Center at the Permian Basin
Odessa, Texas

EDUCATION
MEDICAL
Universidad México Americana Del Norte A.C. Aug.2005- July 2011
Reynosa, Tamaulipas. Mexico
Médico Cirujano Partero (Physician Surgeon Midwife) July 2011

UNDERGRADUATE
University of Texas at Austin, Austin, Texas
B.A. IN BIOLOGY August 2004
B.S. IN NEUROBIOLOGY May 2004
________________________________________
CLINICAL/ WORK EXPERIENCE

PGY-4 ENDOCRINOLOGY FELLOWSHIP July 2018-Present
Texas Tech University Health Sciences Center at the
Permian Basin. Harlingen, Texas

INTERNAL MEDICINE RESIDENCY PROGRAM July 2015-June 2018
UTRGV- VBMC Internal Medicine Residency Program
Harlingen, Texas

SOCIAL/GOVERNMENT SERVICE Aug. 2010-July 2011
Unidad Medica Móvil # 11 (Mobile Health Unit
#11) Reynosa, Tamaulipas. Mexico
Jurisdicción Sanitaria IV, Área de Salud Rural
(State Health Department Jurisdiction IV Clinic
Rural Health Area)

PREGRADUATION INTERNSHIP ROTATIONS July 2009-June 2010
Hospital General de Reynosa “Dr. José María Cantú
Garza” (State of Tamaulipas Health Department’s
General Hospital); Reynosa, Tamaulipas. Mexico

________________________________________
RESEARCH
POSTGRADUATE
POSTER PRESENTATION
1.) Are Smartphones the Answer for Diabetes Control? Nov. 2017
Quality Improvement Project.
Cantu, A.N, & Ansari R. Poster presented at: Texas Chapter of the ACP.
Texas Chapter Annual Meeting; San Antonio, TX, USA

2.) What do you mean Oerskovia, Isn’t That a Contaminant? May 2017
Cantu, A. N., & Ansari, R. Poster presented at:
Texas Chapter of the ACP, Southwest Regional Meeting; Austin, TX, USA.

3.) Is it Neurosyphilis or not? A Contemporary Twist on a Historic Disease? May 2017
Cantu, A.N., & Clarke S. Poster presented at:
Society of Hospital Medicine; Las Vegas, NV, USA.

MEDICAL
MEDICAL SCHOOL THESIS
1.) “Investigación Sobre Morbilidad Asociada Aug. 2010- Jan. 2011
con Comunidades Pertenecientes a Unidad Móvil
Caravanas de la Salud 11 en el Periodo de
Agosto2010 – Enero 2011”
(Research on the Morbidity Associated
with the Rural Communities Visited by Mobile
Health Unit # 11 from August 2010 – January 2011)
Jurisdicción Sanitaria IV, Área de Salud Rural
(State Health Department Jurisdiction IV Clinic
Rural Health Area)
Reynosa, Tamaulipas. Mexico






Ramachandra Chemitiganti

Endocrinology Faculty
Texas Tech University health Sciences Center, Permian Basin, Odessa Texas, Texas

IM/Endocrinology associate Professor

Olga Olson