Presentation
American Association of Clinical Endocrinologists Scientific & Clinical Congress
Date
May 2015
Authors
Joseph Aloi,1 Paul Chidester,2 Amy Henderson,3 Robby Booth,3 Raymie McFarland,3 Melanie Mabrey3
Objective
The aging population and the number of older persons with diabetes is rising in the United States. Approximately 26% of people over age 65 have diabetes (11.2 million elderly adults). The American Diabetes Association and other agencies endorse maintaining blood glucose below 180 mg/dL during inpatient care, yet challenges remain to achieving these goals. This study will attempts to determine if Glucommander, a computerized insulin dosing algorithm, can safely improve glycemic control using 3 different target ranges for patients 80-100 years of age on intravenous insulin (IVI).
Methods
This retrospective study examined 678 patients aged 80-100 years requiring IVI to treat hyperglycemia. Patients were identified by eGMS GlucoSurveillance, a best practice alert triggered when 2 blood glucose (BG) values exceed 180 mg/dL over a 24-hour period. The following glucose targets were evaluated: 100-140, 120-160 & 140-180 mg/dL. Measured outcomes were: (1) Average glucose reduction, (2) % of glucose readings in target, (3) mild hypoglycemia <70 mg/dL (MH) and severe hypoglycemia <40 mg/dL (SH), and (4) average glucose day of discharge.
Results
Patients had an average age of 84 years. Patients with a target BG of 100-140 mg/dL had an average initial BG of 202 mg/dL with an average reduction of 85 mg/dL, 92.3% of readings within target range, hypoglycemia rates of 0.79% MH, 0.03% SH, and day of discharge glucose average of 117 mg/dL. Patients with a target BG of 120-160 mg/dL had an average initial BG of 183 mg/dL with an average reduction of 44 mg/dL, 89% of readings within target range, hypoglycemia rates of 0.54% MH, 0.0% SH, and day of discharge glucose average of 138 mg/dL.
Patients with a target of 140-180 mg/dL had an average initial BG of 289 mg/dL with an average glucose reduction of 135 mg/dL, 89.7% of readings within target range, hypoglycemia rates of 0.3% MH, 0.0% SH, and day of discharge glucose of 154 mg/dL.
| Patients | 678 |
|---|---|
| Age Range | 80 – 100 |
| Average Age | 84 |
| Average Starting BG 100-140 mg/dL | 202 mg/dL |
| Average Starting BG 120-160 mg/dL | 183 mg/dL |
| Average Starting BG 140-180 mg/dL | 289 mg/dL |
Discussion
Our results suggest multiple glucose targets are safely obtained and maintained using treatment with IVI managed by Glucommander for geriatric patients 80 – 100 years of age with an average age of 84 years.
Conclusion
All 3 BG targets resulted in a high percentage of blood glucose values <180 mg/dL, day of discharge blood glucose average around the midpoint of the respective target range, and overall very low rates of MH or SH during treatment with Glucommander.
Affiliations
- Wake Forest Medical Center, Winston Salem, North Carolina.
- Sentara Healthcare, Norfolk, Virginia.
- Glytec, Waltham, Massachusetts.
