The use of clinical pathways in the management of diabetes mellitus emergencies has been shown to improve clinical outcomes. In line with this, The Medical City (TMC) implemented the Clinical Pathway for Hyperglycemic Crises in 2010. Six years after its implementation, a retrospective cross-sectional study comparing the clinical and safety outcomes of pathway-managed versus non-pathway-managed diabetic patients with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) admitted to TMC was completed. There were 95 adult patients documented to have DKA or HHS from January 2010 to April 2016; 60 patients were in the pathway group and 35 patients in the non-pathway group. Clinical and safety outcomes included: (1) time to target capillary blood glucose (CBG) of 140-180 mg/dL, (2) duration of intensive care unit (ICU) stay if admitted at the ICU, (3) duration of hospital stay, (4) hypoglycemic events, (5) hypokalemic events, and (6) mortality. Quantitative variables were summarized as means and standard deviation while qualitative variables were tabulated as frequencies and percentages. Data was analyzed using independent t-test for quantitative variables and Fisher’s exact test for qualitative variables at a level of significance set at 5%. Our results showed that outcomes such as time to reach CBG goal, number of hypoglycemic events, length of ICU stay, and length of hospital stay were similar between the two groups. Patients in the pathway group had significantly more hypokalemic events (54.2% vs. 28.6%, p=0.019) but lower mortality rates (0 vs. 8.6%, p=0.047) compared to the non-pathway group. The use of the TMC Clinical Pathway in the management of hyperglycemic crisis did not shorten the time to reach CBG goal and did not reduce the number of hypoglycemic events. The lower mortality rates observed needs further investigation. Since this is the first study on our hospital’s clinical pathway, a follow up evaluation is recommended for comparison with other studies

Impact of a clinical pathway in the management of hyperglycemic crises in a private tertiary hospital in The Philippines