Comparison of Hyperglycemia Management Protocols in the ICU: Standard Protocol versus eGlycemic Management System

Comparison of Hyperglycemia Management Protocols in the ICU: Standard Protocol versus eGlycemic Management System®

Presentation

American Diabetes Association Scientific Sessions

Date

June 2019

Authors

Jordan Messler,1 Guillermo Umpierrez2

BACKGROUND

A variety of continuous insulin infusion (CII) algorithms are available to improve and maintain glycemic control in the ICU. American Diabetes Association guidelines state that: (a) insulin therapy should be initiated for patients with persistent hyperglycemia >180 mg/dL, (b) a target glucose range of 140-180 mg/dL is recommended for the majority of patients, and (c) more stringent goals, such as 110-140 mg/dL may be appropriate for selected patients if this can be achieved without significant hypoglycemia.

In December 2016, Grady Hospital, a community-based academic medical center with 640 beds, acquired an electronic glycemic management system for use in our ICUs and step-down units (specifically, the eGlycemic Management System® featuring Glucommander™, a product of Glytec).

We present our experience with the eGlycemic Management System® (eGMS®) over a two-year period from December 2016 to December 2018, and we compare glycemic control between patients whose insulin infusion was managed with eGMS® to patients whose insulin infusion was managed with usual care (i.e., “standard protocol”).


DEMOGRAPHICS eGMS® Usual Care
Number of Patients 926 1,971
Average Age (Yrs) 59 57
Gender - Male 49.89% 65.52%
Gender - Female 50.11% 34.48%
Average BMI 33 28
Average A1C 8.51% 7.53%

METHODS

We conducted a retrospective review of critical care patients with persistent hyperglycemia >180 mg/dL who received insulin infusion in an ICU or step-down unit. Among a total of 2,897 patients, 926 (32%) were managed with eGMS® and 1,971 (68%) were managed with usual care.

The primary endpoint of our review was the percentage of blood glucose (BG) readings in the target range of 70-180 mg/dL. Secondary outcomes included the rate of severe hyperglycemia >250 mg/dL measured as the percentage of BG readings and the rates of hypoglycemia <40 mg/dL, <54 mg/dL and <70 mg/dL measured as both the percentage of BG readings and the percentage of patient days.

RESULTS


MEASUREMENTS eGMS® Usual Care Difference in Rate p Value
Average Admission BG (mg/dL) 304 ± 201.37 311 ± 188.00 N/A ---
Average Discharge BG (mg/dL) 172 ± 70.60 211 ± 83.60 N/A ---
Average Reduction in BG During Stay (mg/dL / %) 132 (43.4%) 100 (32.2%) 32.4% greater with eGMS® ---
% BGs 70-180 mg/dL 69.80% 66.34% 5.2% more with eGMS® <0.01
% BGs <40 mg/dL 0.02% 0.44% 95.5% less with eGMS® <0.01
% BGs <54 mg/dL 0.08% 1.02% 92.2% less with eGMS® <0.01
% BGs <70 mg/dL 0.32% 2.44% 86.9% less with eGMS® <0.01
% BGs >250 mg/dL 7.00% 10.10% 30.7% less with eGMS® <0.01
% Patient Days with BG <40 mg/dL 0.19% 1.19% 84.0% less with eGMS® <0.01
% Patient Days with BG <54 mg/dL 0.79% 2.56% 69.1% less with eGMS® <0.01
% Patient Days with BG <70 mg/dL 2.97% 5.70% 47.9% less with eGMS® <0.01

CONCLUSION

Use of eGMS® to manage insulin infusion was superior to usual care in improving glycemic control of critical care patients in the ICUs and step-down units. This included reductions in hypoglycemia, severe hyperglycemia and average blood glucose during the hospital stay. It also included a greater percentage of patients in the target blood glucose range.

AFFILIATIONS

  1. Glytec - Waltham, MA
  2. Emory University School of Medicine - Atlanta, GA
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