Avoiding Hypoglycemia

Ensuring the safety of insulin and avoiding hypoglycemia among diabetic patients has become a critical concern within the VA. More than 10% of all diabetes patients in the VHA experience a hypoglycemic event each year — and with Hba1c levels declining by 0.5% per year within that population, the rates may be rising, says the Diabetes QUERI Center. In addition, a December 2011 study in the Journal of the American Geriatrics Society showed that 20% to 27% of diabetic elderly veterans with cognitive impairment or dementia also suffered from hypoglycemia, making ensuring accurate dosing a high priority.

“While studies show that there is no difference in dosing accuracy between insulin pens and vials and syringes, many of our patients don’t see the lines on the syringes that well, so they guess. The numbers on the pens are easier to read, and they can hear the clicks. They know how many units of insulin they have,” Rucker explained.

To measure success of the program, the VA Montana Healthcare System will monitor glucose management by reviewing patients’ Hba1c levels, checking blood sugar logs and evaluating data that patients download directly from their glucose meters. The pilot team also will track the number and kind of emergency department visits and hospitalizations participants have during the program. Patients also will be surveyed about their views of the pens.

In addition to monitoring patient health and satisfaction, the team will assess staff perceptions online using Survey Monkey. Rucker said she expects the pens will increase satisfaction among healthcare educators and providers.

“If you’ve never drawn up something from a syringe and vial, it is kind of complicated and can be very frustrating for patients and educators,” she said. “It takes a lot more time than showing them how to use an insulin pen. If we can reduce the time spent on that component, we may have more time to teach other self-management skills.”

More than 100,000 employees have submitted nearly 15,000 ideas in the four Employee Innovation Competitions held since 2009. VA employees vote on the ideas using a crowd-sourcing platform, and the most popular are evaluated for implementation. The VA Innovation Initiative Executive Selection Board has funded pilots of 72 of the best ideas to date.

VA plans to introduce successful innovations into regular practice for adoption nationwide.

Already, Rucker has spoken with endocrinologists and nurses at the Nashville VA Medical Center who have expressed interest in the insulin pen program.

Offering options for insulin administration is consistent with the VA’s focus on patient-centered care.

“Everyone’s diabetes is a little different,” Rucker said, “so the one-size-fits-all approach that expects everyone to use an insulin vial and syringe simply doesn’t work.”

Diabetes QUERI Center 2011 Strategic Plan

VA Innovation Initiative

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