With CMS now requiring mandatory reporting of severe hypoglycemia and hyperglycemia events, inpatient glycemic safety has moved from a clinical priority to a visible system-level performance measure.
During a Becker’s Healthcare webinar hosted by Glooko, four healthcare leaders explored where glycemic safety efforts commonly fall short and what it takes to build the consistency, standardization and infrastructure needed to close those gaps.
Below are four key takeaways from the conversation.
1. A new environment
For decades, sliding scale insulin (SSI) has been the default approach to inpatient glycemic management. But the experts agreed that changes are needed to improve the provider and patient experience.
“Sliding scale is ancient and historic and very reactive,” said Lewis Marshall Jr., MD, CMO of NYC Health and Hospitals Lincoln. “And that’s how I think most of us are monitoring our patients with diabetes in the hospital at this point. That’s something we will need to get away from.”
A key problem is that many organizations don’t yet know how poorly they are performing. Paul Chidester, MD, FACP, EndoTool Medical Director at Glooko, noted that awareness itself is a critical first step.
“A lot of hospitals, as they’re beginning to start on this journey, they really do not even know what their performance is,” Dr. Chidester said. “That’s a really big first step.”
CMS’ shift to mandatory public reporting of hypoglycemic and hyperglycemic events beginning in 2026 is accelerating urgency. But panelists emphasized the goal must extend beyond compliance.
2. The greatest downstream risk
Inpatient glycemic management is complicated by constant variability in patient condition, nutrition, acuity level, and care team coordination. Panelists identified transitions of care as particularly high-risk moments where insulin management can break down.
“Hospitalists are turning over every several days, patients are often getting transferred from unit to unit because of acuity and bed availability and often the focus on insulin dosing may be lost,” Dr. Chidester said. “Leaving a patient on a static protocol as they’re moving from different care venues, to different providers, can be a real recipe for disaster.”
Nursing knowledge gaps add another layer of risk. Dr. Chidester described a common scenario in which nurses, alarmed by large basal insulin doses, hold them — triggering the very hyperglycemia the dose was meant to prevent. For Benjamin Slovis, MD, Chief Medical Information Officer at Temple University Health System, documentation gaps compound these issues further. Variability in when finger sticks are performed or insulin is documented can snowball into poor glycemic control and create risk across the entire care timeline.
Harpreet Pall, MD, CMO, at Hackensack Meridian Jersey Shore University Medical Center, pointed to the need for coordinated ownership of this data:
“Making sure that there’s a coordinated approach to some of this data and knowing who’s going to be acting on that data is really important,” Dr. Pall stressed.
3. Why workforce redesign matters
Alert fatigue and poorly designed workflows aren’t just operational inconveniences, they can create meaningful patient safety risks. Panelists stressed that any approach to glycemic improvement must account for the burden placed on frontline nurses.
“Our nurses are asked to increase their cognitive burden throughout the entire process,” Dr. Slovis said. “They are now not only the ones actively caring for the patient at the bedside, but being asked to be an error-catching layer of the entire process.”
The result, Dr. Slovis explained, is that poorly designed workflows push clinicians toward workarounds — not out of negligence, but out of necessity. The responsibility, he argued, lies with leadership:
“It’s not the individual bedside nurse’s job to create an appropriate workflow for management of glucose in the hospital. That’s the job of medical and operational leadership,” Dr. Slovis said.
Dr. Chidester reframed the problem from a different angle: better glycemic control actually reduces nursing workload. In his experience, treating an episode of hypoglycemia or severe hyperglycemia increases workload. They need tools to be able to reduce cognitive burden and reduce the risk of provider burnout.
Decision support tools, panelists agreed, should function as confidence-builders, helping nurses understand why a dose is what it is, rather than flooding them with alerts that prompt unnecessary calls to providers.
4. The keys to success in 2026
Panelists were aligned that technology — predictive analytics, decision support tools, continuous glucose monitoring and remote monitoring platforms — will play a critical enabling role in improving glycemic outcomes. But technology alone won’t be enough.
“Success would be to walk into a hospital and there’s a sign in the lobby that says it’s been 18 days since we’ve had a severe hypoglycemic event. Complete transparency on glycemic control is really where we would love to be,” Dr. Chidester said.
Dr. Slovis echoed that the most important shift may be cultural and treating glycemic events the way health systems now treat catheter-associated infections or ventilator-associated pneumonia: as largely preventable.
Ultimately, as Dr. Pall summarized, technology must serve frontline teams — not complicate their work.
“Whatever systems we implement, it should be used to enable the frontline teams and not just add complexity to their workloads,” Dr. Pall said. “By itself, technology is not the solution, but how it improves the workflow and almost becomes invisible in the background is really the challenge in front of us.”
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