Does the use of a colour coded inpatient capillary blood glucose monitoring chart influence outcomes?

Dhiraj Sharma, Matthew Gerlach, Vivek Sharma, Ketan Dhatariya


Background: Dysglycaemia in hospital inpatients is associated with harm. However, bedside capillary glucose monitoring often occurs with inadequate frequency, with inappropriate action taken when dysglycaemia occurs.

Aims: To assess whether the introduction of a colour coded blood glucose monitoring chart had an impact on glycaemic control, documentation of action taken, length of stay and mortality in an unselected cohort of hospital inpatients.

Methods: A cross-sectional study before (2014) and after (2017) the introduction of the new chart was undertaken. Data were collected for the 24 hours prior to inclusion in the study.

Results: Data from 56 individuals were collected in 2014 and from 161 in 2017. 57% and 22% experienced dysglycaemia in 2014 and 2017, respectively. Action was taken in 24.2% of cases in 2014 and in 56.8% in 2017. Median length of stay was 16.1 days (IQR 8.4–39.4) in 2014 and 13.1 days (5.7–25.3) in 2017. For those who experienced dysglycaemia and in whom action was not recorded, mortality was 30% and 20% in 2014 and 2017 compared with 6% and 15%, respectively, for those who had no dysglycaemia.

Conclusions: The introduction of a colour coded blood glucose monitoring chart led to more action being recorded when dysglycaemia occurred and reduced length of hospital stay and mortality.


diabetes, inpatient, glucose chart, outcomes

Full Text:



Nirantharakumar K, Marshall T, Kennedy A, Hemming K, Coleman JJ. Hypoglycaemia is associated with increased length of stay and mortality in people with diabetes who are hospitalized. Diabet Med 2012;29(12):e445–e448.

Turchin A, Matheny ME, Shubina M, et al. Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care 2009;32(7):1153–7.

Kotagal M, Symons RG, Hirsch IB, et al. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg 2016;261(1):97–103.

Frisch A, Chandra P, Smiley D, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care 2010;33(8):1783–8.

Corsino L, Dhatariya K, Umpierrez GE. Management of diabetes and hyperglycemia in hospitalized patients. 2014.

Baker EH, Janaway CH, Philips BJ, et al. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax 2006;61(4):284–9.

Bruno A, Gregori D, Caropreso A, et al. Normal glucose values are associated with a lower risk of mortality in hospitalized patients. Diabetes Care 2008;31(11):2209–10.

Brodovicz KG, Mehta V, Zhang Q, et al. Association between hypoglycemia and inpatient mortality and length of hospital stay in hospitalized, insulin-treated patients. Curr Med Res Opin 2013;29(2):101–7.

Zapatero A, Gomez-Huelgas R, Gonzalez N, et al. Frequency of hypoglycemia and its impact on length of stay, mortality, and short-term readmission in patients with diabetes hospitalized in internal medicine wards. Endocr Pract 2014;20(9):870–5.

NHS Digital. National Diabetes Inpatient Audit (NaDIA) – 2017. 2018.

Joint British Diabetes Societies Inpatient Care Group. Guidelines for the management of inpatient diabetes. 2014.

Bersoux S, Cook CB, Kongable GL, Shu J, Zito DR. Benchmarking glycemic control in U.S. hospitals. Endocr Pract 2014;20(9):876–83.

McAlister FA, Man J, Bistritz L, Amad H, Tandon P. Diabetes and coronary artery bypass surgery. Diabetes Care 2003;26(5):1518–24.

Pomposelli JJ, Baxter JK, Babineau TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr 1998;22(2):77–81.

Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: A report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013;36(5):1384–95.

Khazai NB, Hamdy O. Inpatient diabetes management in the twenty-first century. Endocrinol Metab Clinics 2016;45(4):875–94.

Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97(1):16–38.

McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ. The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care 2005; 28(4):810–5.

Liebl A, Khunti K, Orozco-Beltran D, Yale JF. Health economic evaluation of type 2 diabetes mellitus: a clinical practice focused review. Clin Med Insights Endocrinol Diabetes 2015;8:13–19.

General Medical Council. Good medical practice. 2014.

Sampson M, Jones C. Joint British Diabetes Societies for Inpatient Care: Clinical guidelines and improving inpatient diabetes care. Diabet Med 2018;35(8):988–91.

Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002;87(3):978–82.



  • There are currently no refbacks.

The Journal of the Association of British Clinical Diabetologists