Adherence to a Hypoglycemia Protocol in Hospitalized Patients: A Retrospective Analysis

Mary Fran Tracy, Carol Manchester, Michelle A. Mathiason, Jeff Wood, Amy Moore

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Hypoglycemia can be a common occurrence in hospitalized patients, both those with and without diabetes. Hypoglycemia poses significant risks to hospitalized patients, including increased mortality.

OBJECTIVES: This was a retrospective pre-post study of hypoglycemic patients in an academic medical center of an intervention to improve timely staff nurse adherence to a hypoglycemia protocol. The number of mild and severe hypoglycemia events pre- and postintervention, timeliness of adherence to the hypoglycemia protocol, the number of treatment interventions, and time to return patients to euglycemia were analyzed.

METHODS: Data from hospitalizations of patients who experienced hypoglycemia (<70 mg/dl) and met inclusion criteria 1 year prior to intervention and 3 years postintervention were extracted, including demographics, glycemic control medications, diagnostic-related group, length of stay, and Charlson comorbidity index. For clarity and to determine if any significant change was sustained, the analysis compared data from 1 year prior to intervention to the second-year postintervention.

RESULTS: A total of 7,895 unique hypoglycemic events in 3,819 patients experiencing 20,094 hypoglycemic measures were included in the analysis. Patients were primarily adult, female, and White. Only 58.7% of the sample had diabetes; the median Charlson comorbidity index was 6. Results demonstrated improvement postintervention to registered nurse hypoglycemia protocol adherence regardless of age category or hypoglycemia severity. There was a significant reduction in median time from the first hypoglycemia measure to the second measure. In addition, there was a significant difference in the number of treatment interventions and reduction in time from the first hypoglycemia measure to return of patient to a blood glucose of ≥70 mg/dl.

DISCUSSION: These study results support that the use of a standardized hypoglycemia protocol and appropriate nurse workflows enables nurses to manage hypoglycemia promptly and effectively in most acute and critically ill hospitalized patients. Results also supported a differentiation in nurse workflow for patients with mild versus severe hypoglycemia. Implementing these interventions may result in avoidance or mitigation of the potential consequences of severe and/or sustained hypoglycemia.

Original languageEnglish (US)
Pages (from-to)15-23
Number of pages9
JournalNursing research
Issue number1
StatePublished - Sep 30 2020

Bibliographical note

Funding Information:
Mary Fran Tracy is now Associate Professor, University of Minnesota School of Nursing, Minneapolis. The authors would like to acknowledge the nursing staff at the University of Minnesota Medical Center who provide quality care for these patients and Tatiana Ditta, Data Analyst, Fairview Health Services, University of Minnesota Medical Center. Funding for biostatistical support was provided by the University of Minnesota Medical Center, Department of Nursing, Fairview Health Services. Study approval was received from the University of Minnesota Institutional Review Board. Data were extracted only from charts of patients who had agreed to have their information used for the purposes of research. The authors have no conflicts of interest to report. Corresponding author: Mary Fran Tracy, PhD, RN, APRN, CNS, FCNS, FAAN, University of Minnesota School of Nursing, 5–140 Weaver-Densford Hall, 308 Harvard St. SE, Minneapolis, MN 55455 (e-mail:

Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.


  • adherence
  • hypoglycemia
  • protocol
  • Humans
  • Middle Aged
  • Child, Preschool
  • Infant
  • Male
  • Midwestern United States
  • Young Adult
  • Blood Glucose/analysis
  • Hypoglycemia/chemically induced
  • Aged, 80 and over
  • Adult
  • Female
  • Hospitalization/statistics & numerical data
  • Retrospective Studies
  • Child
  • Infant, Newborn
  • Risk Factors
  • Critical Illness/therapy
  • Medication Adherence/statistics & numerical data
  • Diabetes Complications/drug therapy
  • Adolescent
  • Aged
  • Hypoglycemic Agents/adverse effects

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article


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