CDR 14: Process: Blood glucose check prior to hyperbaric oxygen therapy (HBOT) treatment
MEASURE STEWARD:
US Wound Registry and the Undersea and Hyperbaric Medical Society (UHMS)
This measure was developed via a consensus process in collaboration with the Undersea and
Hyperbarics Medicine Society (UHMS) Quality Measure Committee.
DESCRIPTION:
Percentage of HBOT treatments of patients aged 18 years and older who had their blood glucose level
assessed prior to undergoing hyperbaric oxygen therapy
NUMERATOR:
All HBOT visits with documentation of serum glucose determination at the time of the treatment.
DENOMINATOR:
All HBOT visits with documentation of serum glucose determination at the time of the treatment.
RATIONALE:
Studies show all patients undergoing hyperbaric oxygen therapy (HBOT) experience a reduction in blood
glucose levels compared to pre-hyperbaric oxygen treatment levels. In 2005, a retrospective analysis of
13,510 hyperbaric oxygen therapy treatment records from 25 clinics. Among the 10,277 encounters in
which the patients’ initial glucose was >150 and who were given no feeding prior to HBOT, the average
decrease in blood sugar was 36.1 mg/dl and in 4.2% of treatments, the post treatment glucose was <100
mg/dL. Among the patients who were fed prior to HBOT, 11.6% presented with glucose < 100 and
despite feeding, in 19.6% of 3,277 encounters, the patient had a post-HBOT glucose < 100.
In another observational study, insulin-dependent patients experienced a more severe decrease in
blood glucose than non-insulin dependent patients with 19% of NIDDM patients having a drop of 72
mg/dL or more and requiring intervention before HBOT. The mechanism of this possible effect of HBOT
has not been elucidated. However, studies have shown an increase in activity of insulin-receptor sites
and changes in insulin sensitivity due to up-regulation of PPAR-γ signaling associated with hyperbaric
oxygen. In one study, insulin sensitivity increased within 3 days of hyperbaric oxygen treatment, and this
was maintained for 30 sessions. Animal studies also have shown HBOT has a direct effect on the
enhancement of glucose metabolic capacity and uptake in the skeletal muscle. It is possible that the
observed decreases in serum blood sugar are simply an effect of the timing of hyperbaric therapy in
conjunction with the peak effect of diabetes medications. Since patients are usually not able to eat or
drink ad lib during HBOT, the drop in blood sugar may be coincidental with the end of the hyperbaric
session. This does not mean that the effects are benign since a decrease in serum blood sugar has been
associated with a variety of side effects of HBOT such as otic barotrauma as well as hyperoxic seizure.
Diabetic patients whose blood sugar is evaluated prior to HBOT and who are provided with a source of
glucose if the levels are <120 mg/dL are less likely to have significant decreases in blood glucose
following HBOT. Since the side effect profile of HBOT is relatively low, it is unclear how much the risk of
HBOT is increased by failing to assess blood glucose prior to treatment. However, serum blood glucose is
©2016-2017 Chronic Disease Registry, Inc. d/b/a U.S. Wound Registry, The Woodlands, Texas
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a commonly performed, safe, low risk test which provides valuable information regarding the status of a
diabetic patient. It should be remembered that patients who undergo HBOT, particularly in monopolace
chambers (the most commonly used type), are physically separated from medical staff inside the
pressure vessel. Should a healthcare emergency arise, several minutes are required to decompress the
chamber before clinicians have physical access to the patient. Extremes of serum blood glucose (high or
low) can affect the patient’s mental status and ability to verbally communicate his or her state of
physical status during HBOT. Thus, it is medically advisable to know whether the patient’s blood sugar is
within a normal range prior to initiating a medical treatment like hyperbaric oxygen therapy.
Patients whose fingerstick blood glucose levels are <120 mg/dL may receive oral calorie intervention
before HBOT as well as a post treatment reassessment of blood sugar. However, whether oral calorie
intervention is appropriate depends on many complex factors including the timing of the patient’s most
recent meal and the time and type of their previously administered diabetes medications. This decision
should be made by the hyperbaric physician supervising the administration of HBOT therapy.
CLINICAL RECOMMENDATION STATEMENTS:
There is general consensus that best practice to help ensure the safety of patients undergoing HBOT is
to measure blood glucose via finger stick on all diabetic patients prior to HBOT.
1. Warriner R, Paceri P, Fife C, Ta-Da G, Otto G. Pre and post HBOT blood glucose levels, an
observational study of diabetic patients. Abstract presented at the Undersea and Hyperbaric
Medical Society Annual Scientific Meeting, Las Vegas, NV, June 16- 18, 2005.
2. Lo T, Delamora N, Swearingin K, Moore P, Daher N. Blood Glucose Fluctuation During Hyperbaric
Oxygen Therapy in Diabetic vs. Non-Diabetic Patients: Is there a Difference? Abstract presented
at the Undersea and Hyperbaric Medical Society, Inc. Annual Scientific Meeting, Las Vegas, NV.
June 25–27, 2009.
3. Trytko B. Does hyperbaric oxygen affect blood sugar levels in diabetics? J South Pacific
Underwater Medicine Society (SPUMS). 2002;32(3). Available at: http://archive.rubiconfoundation.org/7686. Accessed
4. Wilkinson D, Chapman IM, Heilbronn LK. Hyperbaric oxygen therapy improves peripheral insulin
sensitivity in humans. J Br Diabet Assoc. 2012;29(8):986–989.
5. Fujita NL, Nagatomo F, Murakami S, Kondo H, Ishihara A, Fujino H. Effects of hyperbaric oxygen
on metabolic capacity of the skeletal muscle in type 2 diabetic rats with obesity. Sci World J.
2012:637978.doi: 10.1100/2012/637978.
©2016-2017 Chronic Disease Registry, Inc. d/b/a U.S. Wound Registry, The Woodlands, Texas
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