Safety and Efficacy of eGlycemic Management System® among Labor and Delivery Patients at a Not-for-Profit Hospital in Hawaii

Safety and Efficacy of eGlycemic Management System® among Labor and Delivery Patients at a Not-for-Profit Hospital in Hawaii

Presentation

Annual Diabetes Technology Meeting

Date

November 2018

Authors

Venkataraman Balaraman, Pushpa Rayasam, Raymie McFarland

BACKGROUND

The American College of Obstetrics and Gynecology recommends tight glycemic control (blood glucose <110 mg/dL) during labor and delivery in patients with type 1, type 2 and gestational diabetes to minimize risk of neonatal hypoglycemia. Inherently, this targeted treatment can be associated with higher risk of complications, especially hypoglycemia in the mother as she is already in a potentially ketotic state.

OBJECTIVE

The objective of this study was to evaluate if the Glytec® eGlycemic Management System® (eGMS®) safely supports tight glycemic control, with minimal episodes of hypoglycemia, among labor and delivery patients with diabetes who receive antepartum and intrapartum intravenous (IV) insulin therapy.

METHODS

This retrospective quality improvement study examined rates of moderate hypoglycemia <70 mg/dL, severe hypoglycemia <54 mg/dL and extreme hypoglycemia <40 mg/dL as primary outcomes as well as moderate hyperglycemia >180 mg/dL and median time to target (80-120 mg/dL) as secondary outcomes. Included in the study were patients admitted to a not-for-profit tertiary birthing facility in Honolulu, Hawaii from November 2015 through June 2018 who were managed using eGMS®.


Patient Demographics
Characteristic Value SD
Number of Patients 204
Average Age (years) 29
Average A1C (%) (n=92) 7.16
Average Height (cm) 161
Average Weight (kg) 94.30
Average Initial BG (mg/dL) 152 51.44
Average Final BG (mg/dL) 113 32.77
Average of all BGs First Day (mg/dL) 128 43.94
Average of all BGs Last Day (mg/dL) 117 31.33
Average Length of Stay (days) 4.71
Total Number of POC Glucose Tests 4,174
Median Time to Target (hrs) 6.0
Median Time on eGMS® (hrs) 7.0

RESULTS

  • Percent blood glucoses <40 mg/dL were 0.14%. Percent patient days <40 mg/dL were 1.03%.
  • Percent blood glucoses <54 mg/dL were 0.53%. Percent patient days <40 mg/dL were 1.72%.
  • Percent blood glucoses <70 mg/dL were 2.35%. Percent patient days <40 mg/dL were 7.59%.
  • Percent blood glucoses >180 mg/dL were 7.19%. Percent patient days <40 mg/dL were 15.17%.

DISCUSSION

eGMS® offers a safe and effective approach to managing IV insulin for labor and delivery patients with diabetes, and results in minimal hypoglycemia. It is an easy-to-use alternative to complex paper-based protocols and can be adopted in busy, high-volume facilities that treat high-risk patients. In the future, it will be desirable to study the impact of eGMS® on incidence of neonatal hypoglycemia requiring admission to the NICU for IV dextrose therapy.

CONCLUSIONS

eGMS® Glucommander™ provided a decreased CCU length of stay of .25 days compared to standard protocols. Patients treated using eGMS® Glucommander™ experienced less overall hypoglycemia than patients treated using standard protocols, and eGMS® Glucommander™ was more effective at reaching ADA targets for average daily blood glucose and final blood glucose.

Request Demo