Computerized Algorithm Can Enable Tight Glycemic Control

Computerized Algorithm Can Enable Tight Glycemic Control

News Site:  MD Magazine
Date:  June 28, 2010

What if your facility could safely and effectively achieve tight glycemic control among patients in the intensive care unit (ICU) with little danger of severe hypoglycemia? According to study results presented at the American Diabetes Association 70th Scientific Sessions, this outcome is possible through the use of Glucommander, a computerized algorithm that accurately manages intravenous insulin.

In their poster, titled “A Computerized Intravenous Insulin Controller (CIIC) Shows Significantly Less Hypoglycemia than NICE-SUGAR and Five Paper Protocols for Intensive Control--0.3% vs. 10.6%,” Paul Davidson, MD, and colleagues reported their findings from a study that compared hypoglycemia rates among patients in hospitals that used Glucommander to manage insulin to the rates seen in patients in the NICE-SUGAR trial and in patients who were managed using various “tight-control paper protocols."

The authors noted that “studies have shown excessive rates of hypoglycemia” in ICU patients (rates from the studies they cited range from 5.2% to 28.6%, with a mean rate of 10.6%), despite efforts at effective blood glucose management, leading the ADA and AACE to issue what the authors labeled as “compromise” guideline revisions that accept blood glucose levels in these patients that “were previously associated with increased complications.”

The Glucommander computerized intravenous insulin controller (CIIC) for insulin dosing enables providers to avoid hypoglycemia by accurately controlling patients’ blood glucose to desired target levels. The Glucommander system alerts staff to measure patients’ blood glucose and can make adjustments to patients’ insulin doses to “prevent excursions outside the target range. When a patient’s blood glucose decreases, the system will phase out insulin while enteral or parenteral nutrition continues and can augment the patient’s carbohydrate intake with a titrated solution of 50% dextrose in water (D50), “correcting the glucose level to mid-target range.”

The authors presented data comparing the number of patients in the NICE-SUGAR trial and the number of patients managed with tight-control paper protocols who had at least one blood glucose reading of less than 40 mg/dl to the number of Glucommander patients who did. In the NICE-SUGAR trial, 6.8% of patients had at least one blood glucose of less than 40 mg/dl. In the tight-control paper protocols group, 12.6% of patients had at least one blood glucose of less than 40 mg/dl. Only 0.3% of Glucommander patients met this criteria.

These results led the authors to conclude that “It is possible with the Glucommander to implement tight glycemic control in all institutions” and to achieve the ideal 110-140 [mg/dl blood glucose] range cited by the ADA and AACE.” They advise more hospitals to implement this “effective, safe, and more normoglycemic algorithm in an accurate, computer-controlled system.”

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