Diabetes is a significant problem in the health care arena today, impacting morbidity and mortality. Approximately 1.3 million people aged 20 years or older are newly diagnosed each year with diabetes. Additionally, obesity, has now reached epidemic levels, affecting nearly 21 % of our nation's population, which has been linked to the development of diabetes and other chronic illnesses. In the hospital setting, hyperglycemia represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes. In an effort to contain health care costs, and improve patient outcomes, it is essential to identify hyperglycemia at the time of hospital admission and to implement therapy to achieve good glycemic control. It is therefore essential to raise the awareness of health care professionals, regarding the significance of maintaining good glycemic control in the inpatient setting, as it directly impacts short and long term outcomes.
Using Betty Neumanís Systems Model and Psychophysiology of Stress according to Hans Selye, a pre-post retrospective comparison of hospital length of stay and blood glucose levels for patients who were admitted with a primary or secondary diagnosis of diabetes mellitus was performed. This study revealed that those patients included in the experimental group, whose care was guided by a newly developed diabetes order set had shorter lengths of stay and lower mean blood glucose levels during hospitalization. Though the results were not of statistical significance, they were of practical importance.
Advanced practice nurses (APNs) are becoming increasingly involved in primary, and secondary care in the inpatient setting, and therefore, maintain the responsibility for making contributions to quality health care, particularly for vulnerable populations, such as individuals with diabetes. Individuals with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have a worse prognosis than people without diabetes. Due to the chronic nature of this debilitating disease, and its impact on large patient populations, all APNs, regardless of area of expertise, must aggressively expand their knowledge base regarding diabetes, and associated potential outcomes. Advanced practice nurses play an integral role in identifying key practice problems in the acute care setting, conducting research to identify standards of care that are supported by evidenced-based practice and then utilizing those research findings to develop protocols and procedures which will enhance practice standards and ultimately improve patient care and outcomes.