eGlycemic Management System Safely Achieves Rapid and Sustained Glycemic Control in Kidney Transplant Patients and Reduces Risk of Hypoglycemia Compared to Standard Treatment Protocols
American Diabetes Association Scientific Sessions
Joseph Aloi,1 Raymie McFarland,2 Jadeesh Ullal,3 Melanie Mabrey,2,4 Kathy Price Ward3
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.
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).
- 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.
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.
|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|
|Mean BG||163||< 0.0001||200|
|Standard Deviation||57||< 0.0001||87|
|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|
|Mean BG||163||< 0.0001||178|
|Standard Deviation||57||> 0.2||60|
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.
- 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.