Comparison of Hyperglycemia Management Protocols in the ICU: Standard Protocol versus eGlycemic Management System
American Diabetes Association Scientific Sessions
Jordan Messler,1 Guillermo Umpierrez2
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”).
|Number of Patients||926||1,971|
|Average Age (Yrs)||59||57|
|Gender – Male||49.89%||65.52%|
|Gender – Female||50.11%||34.48%|
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.
|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|
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.
- Glytec – Waltham, MA
- Emory University School of Medicine – Atlanta, GA