Taking Insulin e-Therapy to Heart
Cardiovascular (CVD) patients receiving personalized insulin therapy using a software-based hyperglycemia management program had dramatically fewer hospital readmissions than those given standard care, according to two studies from Mountain States Health Alliance health care system.
The retrospective studies focused on readmission rates for three patient populations admitted for CVD indications between January and December 2015. The results showed that compared with patients treated with standard care, coronary artery bypass graft patients were readmitted 68% less often with the software program; congestive heart failure patients were readmitted 65% less often; and acute myocardial infarction patients were readmitted 36% less often, the investigators reported at the 2016 Annual Diabetes Technology Meeting.
Mountain States had previously tried to achieve tighter glycemic control through a large-scale improvement initiative in collaboration with several other large health care organizations. “We looked at tracking and evaluating what our target blood glucose [BG] levels should be, and we also looked at the ability of our clinicians to manage blood sugars on their own by improving order sets and education,” said Tamera Parsons, the vice president for quality and patient safety for the 13-hospital system, based in Tennessee. “However, in spite of these efforts, we found we were not realizing our goals and achieving best practice, so we opted to adopt more of a technologic approach.”
Their choice – the eGlycemic Management System (eGMS) from Glytec – provides automated surveillance that alerts care teams to patients who have BG outside a designated range, interfacing with laboratory information systems and electronic health records. “We found that eGMS ... enables timely blood sugar checks; and it helps ensure we administer the appropriate amount of insulin at the right time,” Ms. Parsons said. “It is especially helpful when patients experience dramatic fluctuations in blood sugars, which is true of many critical care patients. eGMS also enables us to transition patients from IV to subcutaneous insulin in a smoother manner, and maintain tight glycemic management from one therapy to the other.”
The eGMS also has allowed the hospital system to adopt basal–bolus therapy, the recommended standard of care for subcutaneous insulin, and shift away from antiquated and unsafe sliding-scale therapy.
In addition to reducing readmissions, eGMS helped Mountain States’ cardiac surgery division achieve a decrease in deep sternal wound infection rates to 0%, a reduction in average length of stay by one day, and a reduction in the number of point-of-care BG tests by 16.8 tests per patient.
Previous research has shown that the software program also can reduce episodes of hypoglycemia, a common adverse effect of poorly managed BG.
The researchers said they plan to draft an article for publication this year on both of the readmission studies.
R. Keith Campbell, MBA, a professor emeritus of pharmacotherapy at Washington State University College of Pharmacy, in Spokane, reviewed the Glucommander suite of proprietary dosing algorithms for IV, subcutaneous and pediatric insulin dosing that form the basis of eGMS when the system was first developed.
“There are hundreds of studies showing that if a patient’s blood sugar averages more than 200 [mg/dL], the death rate increases, length of stay increases, the incidence of infection increases and the readmission rate increases,” Mr. Campbell said. “This is a really simple, easy program that you can rapidly train medical assistants and ward nurses to use in a way that improves management of blood sugars for people who are hospitalized. I think every hospital in the country should be using it.”