Proactive Monitoring and Response System Enhances Inpatient Diabetes Safety

Hospitalized patients with diabetes mellitus are vulnerable to medication-related hypoglycemia and hyperglycemia, particularly as newer therapies become part of increasingly complex inpatient regimens. If not recognized and treated promptly, these events can lead to preventable complications and longer hospital stays. Reducing this risk requires systematic surveillance and coordinated care that extends from admission through discharge and recovery. A multidisciplinary team in Singapore has now introduced an end-to-end model designed to support safer diabetes management across the full inpatient care pathway.

At the National University Hospital (NUH), the Inpatient Diabetes Mellitus (DM) management team has implemented a coordinated safety model that links proactive monitoring, rapid bedside response, and structured transition processes. The approach is designed to strengthen safe prescribing while enabling patients to benefit from contemporary diabetes therapies. It is delivered through joint work by physicians, advanced practice nurses, pharmacists, and care coordinators.

Central to the model is SPARK, a digital monitoring program embedded within NUH’s electronic medical record. SPARK continuously screens inpatient data and flags patients at risk of poor glycemic control for early specialist review, rather than waiting for alerts or deterioration. Established as the ProActive Service in 2018, it makes the Inpatient DM team the first touchpoint for higher‑risk patients.

The ProActive Service includes patients admitted with diabetic ketoacidosis, hyperosmolar hyperglycemic state, or severe hypoglycemia; patients with diabetes who have undergone coronary artery bypass grafting; and patients with diabetes in surgical and cardiology wards who develop dysglycemia. In the program, hyperglycemia is defined as two or more point‑of‑care blood glucose readings above 20 mmol/L within 48 hours, and hypoglycemia is defined as a point‑of‑care blood glucose below 2.5 mmol/L within 48 hours. By intervening earlier, the team aims to optimize glucose control, support wound healing, lower infection risk, and facilitate recovery during hospitalization.

Complementing SPARK is HypoBox, a nurse‑led, ready‑to‑use emergency kit placed in wards and clinics to standardize rapid treatment of hypoglycemic events. The kit brings fast‑acting glucose, complex carbohydrate options, and stepwise management guidance to the point of care so nurses can act promptly and consistently. Since implementation, more patients have achieved hypoglycemia rescue within the recommended target time, reducing practice variability and enhancing safety.

Together, SPARK, HypoBox, safe‑prescribing practices, and coordinated care transitions form an integrated safety ecosystem that NUH showcased during multidisciplinary grand rounds held in conjunction with World Patient Safety Day 2026.

“HypoBox began as a ground-up effort to make hypoglycaemia treatment faster, simpler and more consistent for frontline staff. During a hypoglycaemic event, every minute matters. We wanted nurses to have immediate access to the right treatment and clear instructions so they could act without delay. Through the train-the-trainer approach, we have built capability across the organisation and strengthened confidence in delivering safe diabetes care,” said Ms Heng Boon Ling, Advanced Practice Nurse in the Nursing Department at National University Hospital.

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