The ADA update also fell in line with an existing policy at Bronson Methodist Hospital in Kalamazoo, Michigan, said compliance and point-of-care coordinator Erika Deaton-Mohney, MT(ASCP). “But we felt it was best to eliminate confusion.” “We ended up aligning our values with the ADA hypoglycemia protocols with the understanding that the change wasn’t based really on a study,” he explained. At UNC, adopting the new value helped avoid any future misunderstandings or miscommunications about patients’ care, according to Cotten. To Change or Not to ChangeĬlinical laboratories and institutions will need to decide for themselves whether the new critical value is appropriate, said Steven Cotten, PhD, DABCC, NRCC, FAACC, co-director of clinical chemistry at UNC Hospitals in Chapel Hill, North Carolina. With many factors involved, the decision will not be one-size-fits-all. For many in the field, that has called into question the need for a revised critical value, especially as making this change could create significant protocol pivots and shift workloads for laboratorians and providers alike, potentially straining already stressed resources.īecause monitoring patients’ glucose can play a critical role in many aspects of their medical care, clinical laboratorians are carefully considering whether to institute this new critical hypoglycemia value. The trail of references cited for the change eventually leads to a single 30-year-old study that involved only 10 people who did not have diabetes (Am J Physiol 1991 260:E67–74). Although the healthcare community generally hews closely to ADA standards, this move has been met with some doubt and disagreement among clinical laboratorians.Ĭonversation around the updated value perhaps has been more animated than other ADA recommendations because of the scant evidence behind it. This change, representing a new critical value, was based on a consensus report issued in 2017 by ADA and seven other organizations on standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes (Diabetes Care 2017 40:1622-30). In January 2019, the American Diabetes Association (ADA) in its annual standards of medical care in diabetes released new guidance, classifying level 2 hypoglycemia as a glucose value <54 mg/dL, the threshold at which “neuroglycopenic symptoms begin to occur and requires immediate action to resolve the hypoglycemic event” (Diabetes Care 2019 42(Suppl.
0 kommentar(er)
