eGlycemic Management System Safely Achieves Rapid and Sustained Glycemic Control in Kidney Transplant Patients and Reduces Risk of Hypoglycemia Compared to Standard Treatment Protocols

Presentation

American Diabetes Association Scientific Sessions

Date

June 2015

Authors

Joseph Aloi,¹ Raymie McFarland,² Jadeesh Ullal,³ Melanie Mabrey,^2,4 Kathy Price Ward³

Objective

Management of patients with steroid-induced hyperglycemia can be difficult. Intravenous insulin infusions are generally recommended for flexibility with dynamic insulin requirements. Blood glucose control in patients undergoing renal transplant is particularly difficult as high-dose steroids, immunosuppression and renal function each play an important but varying contribution to insulin resistance.

Methods

Record review: 11 patients treated with Glucommander IV (GM), a computerized IV insulin dosing algorithm, to examine the ability of GM to safely achieve glycemic targets versus standard insulin infusions (SII).

Inclusion criteria:

Renal transplant
1 blood glucose (BG) >200 mg/dL or 2 BGs >180 mg/dL
Treated with GM during the post-operative period

Glucose results were collected for the patient’s entire IV insulin treatment.

Results

Prior to treatment with GM, patients’ mean BG was 200 mg/dL + 87; during treatment with GM patients’ mean BG was 163 mg/dL + 57. Patients continuing IV insulin with SII after GM discontinuation had a mean BG of 178 mg/dL + 60. Hypoglycemia <70 mg/dL was 2% prior to treatment with GM, 0.7% during treatment with GM, and 1% after discontinuation of GM. Percentage of glucose results in goal was 68% with GM versus 45% before and 55% after.

	Glucommander			Pre-Glucommander
	N	%	P-Value	%	N
Patients	11				10
NBGs	803				85
BGs < 70	6	0.7%	> 0.1	2%	2
BGs 71-180	549	68%	< 0.0001	45%	38
BGs > 180	248	31%	< 0.0001	53%	45
	Value		P-Value		Value
Mean BG	163		< 0.0001		200
Standard Deviation	57		< 0.0001		87

	Glucommander			Post-Glucommander
	N	%	P-Value	%	N
Patients	11				11
NBGs	803				301
BGs < 70	6	0.7%	> 0.7	1%	3
BGs 71-180	549	68%	< 0.0001	55%	165
BGs > 180	248	31%	< 0.0001	44%	133
	Value		P-Value		Value
Mean BG	163		< 0.0001		178
Standard Deviation	57		> 0.2		60

Conclusions

Renal transplant patients treated with Glucommander achieved a higher percentage of BG results in goal, lower mean glucose levels, less hypoglycemia, and lower glucose variability compared to patients on SII.

Affiliations

Wake Forest Baptist Medical Center, Winston Salem, North Carolina.
Glytec, Waltham, Massachusetts.
Sentara Healthcare System, Norfolk, Virginia.
Duke University School of Nursing, Durham, North Carolina.

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