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.
