Quality Committee
Meeting
May 18, 2026
10:00am - 11:00am Eastern Time
Announcements
Measure Review
●GLU-12/13 - Beth Duggan, MD, University of Alabama Birmingham
●GLU-09/10/11 - Patrick Henson, MD, Vanderbilt University
Best Practice Exchange (time permitting)
●Hyperglycemia Management - Ketan Chopra, MD, Henry Ford
Health System
Measure Revision Updates (time permitting)
Agenda
Meeting Minutes
February 23, 2026
Roll Call – via Zoom or contact
MPOG
Upcoming Events
2026 Meetings
Friday, July 17, 2026
ASPIRE Collaborative Meeting
Weber’s Hotel, Ann Arbor, MI
Friday, October 16, 2026
MPOG Retreat, San Diego, CA
Announcements
MPOG Measure quality review:
GLU-09, GLU-10, GLU-11
C. Patrick Henson, DO
Professor, Department of Anesthesiology
Division of Anesthesiology Critical Care Medicine
Vanderbilt University Medical Center
Measures
•GLU-09
•Timing - Anesthesia start to anesthesia end (intraoperative)
•Inclusion - BG>180
•Success = Treatment or recheck of high BG within 90 minutes
•GLU-10
•Timing - Preop start to PACU end (perioperative)
•Inclusion - BG>180
•Success = Treatment or recheck of high BG within 90 minutes
•GLU-11
•Timing - Preop start to PACU end (perioperative)
•Inclusion - BG>180
•Success = Treatment of high BG within 90 minutes
Exclusions: children, ASA 5+6, OB, <30 min, ambulatory <4 hours
History
•Acute hyperglycemia in perioperative patients is associated with impaired wound
healing, infection, mortality, length of stay and acute kidney injury
•Preoperative, intraoperative, postoperative glycemic control all implicated in
outcomes
•Treatment with insulin to maintain blood glucose <180 associated with reduced risk
of complication
History
•Treatment paradigms ‘borrowed’ from large critical care randomized control trials: most
recently NICE-SUGAR (2009)
•Target BG<180 mg/dL associated with lower ICU mortality compared with
aggressive target BG 81-108 mg/dL
•Studies of some groups (cardiac surgical, vascular, complex hepatobiliary, thoracic,
others) have suggested optimal target of 80-110 mg/dL, <150 mg/dL, and other
regimens.
•Several smaller studies of perioperative patients have reinforced BG target 80-180 mg/dL
to reduce risk of hyperglycemic complications in all groups, and target BG 140-180
mg/dL likely the optimal range to combine benefit with reduced risk of hypoglycemic
events
•Mirror recommendations from national societies (ADA, Endocrine Society, SCCM);
ambulatory recommendations more relaxed (SAMBA)
New Information
•Smaller RCTs and observational studies that reinforce maintenance of BG below 180
mg/dL to be associated with reduced complications (supports GLU-09/10/11)
•Large trial of insulin dosing reminder vs. glucose check reminder did not result in
improvement in postoperative hyperglycemia
•supports maintaining “management” measures (GLU-09/11) in addition to
“treatment” measure (GLU-10)
•Additional evidence to support monitoring BG in patients without diagnosis of
diabetes mellitus
•Supports inclusion of all patients with BG value checked, not simply those with
diabetes mellitus
•Societal recommendations support upper limit of 180 mg/dL as threshold in
hospitalized and perioperative patients
New Information
•Overall, new data supports:
•Continue to monitor blood glucose in patients who have
evidence of hyperglycemia
•Including patients with and without a diagnosis of diabetes
•Maintain blood glucose in range of 100-180 mg/dL
•Value in measurement as well as treatment
GLU-XX Measures
•All measures include patients with:
•Documented BG value >180 mg/dL
•All measures EXCLUDE patients with:
•ASA class 5 or 6
•Short duration (<30 minutes)
•Outpatient cases <4 hours
•Non-labor/cesarean procedures
GLU-XX Measures
•GLU-09 and GLU-10 measures include patients:
•Aged 12 and older
•GLU-11 measure includes patients:
•Aged 18 and older
Review
•90 minute time frame is relaxed but appropriate
•Inclusion of all patients with hyperglycemia is appropriate, should not
limit to only diabetic patients
•180 mg/dL is appropriate upper limit of normal/threshold for success
•Excluding obstetric deliveries seems appropriate, given the unclear
data around treating hyperglycemic parturients
Review
•Unclear how early BG values are handled in “Preop” phases (GLU-09 and GLU-10)
•What happens with a case where BG is checked over 90 minutes before
patient is seen by anesthesia provider/missed time for recheck?
•Nearly half of my institutions cases are excluded for outpatient case <4 hours criteria
•Ambulatory measures in development
•Are we comfortable with keeping these cases separate?
•Age range is conflicting - 12+ versus 18+
•What is the value of including the adolescent age range (12-17) in these
“adult” measures?
•ASA 5 patients excluded
•A sicker cohort of emergency patients, but potentially one that might
benefit from proper glucose monitoring
Recommendations
•GLU-09 is the best measure of intraoperative management
•Discuss: modification of age, ASA 5
•GLU-10 is the broadest in scope, includes perioperative period and
treatment or recheck as measure of success
•Discuss: modification of age, ASA 5
•GLU-11 is the broadest in scope, includes perioperative period with
only treatment as measure of success
•Discuss: timetable considerations
Thank you!
