Safety and Efficacy of eGlycemic Management System among Labor and Delivery Patients at a Not-for-Profit Hospital in Hawaii
Presentation
Annual Diabetes Technology Meeting
Date
November 2018
Authors
Venkataraman Balaraman, Pushpa Rayasam, Raymie McFarland
BACKGROUND
The American College of Obstetrics and Gynecology recommends tight glycemic control (blood glucose <110 mg/dL) during labor and delivery in patients with type 1, type 2 and gestational diabetes to minimize risk of neonatal hypoglycemia. Inherently, this targeted treatment can be associated with higher risk of complications, especially hypoglycemia in the mother as she is already in a potentially ketotic state.
OBJECTIVE
The objective of this study was to evaluate if the Glytec® eGlycemic Management System® (eGMS®) safely supports tight glycemic control, with minimal episodes of hypoglycemia, among labor and delivery patients with diabetes who receive antepartum and intrapartum intravenous (IV) insulin therapy.
METHODS
This retrospective quality improvement study examined rates of moderate hypoglycemia <70 mg/dL, severe hypoglycemia <54 mg/dL and extreme hypoglycemia <40 mg/dL as primary outcomes as well as moderate hyperglycemia >180 mg/dL and median time to target (80-120 mg/dL) as secondary outcomes. Included in the study were patients admitted to a not-for-profit tertiary birthing facility in Honolulu, Hawaii from November 2015 through June 2018 who were managed using eGMS®.
| Patient Characteristics | Value | SD |
|---|---|---|
| Number of Patients | 204 | |
| Average Age (years) | 29 | |
| Average A1C (%) (n=92) | 7.16 | |
| Average Height (cm) | 161 | |
| Average Weight (kg) | 94.30 | |
| Average Initial BG (mg/dL) | 152 | 51.44 |
| Average Final BG (mg/dL) | 113 | 32.77 |
| Average of all BGs First Day (mg/dL) | 128 | 43.94 |
| Average of all BGs Last Day (mg/dL) | 117 | 31.33 |
| Average Length of Stay (days) | 4.71 | |
| Total Number of POC Glucose Tests | 4,174 | |
| Median Time to Target (hrs) | 6.0 | |
| Median Time on eGMS® (hrs) | 7.0 |
RESULTS
- Percent blood glucoses <40 mg/dL were 0.14%. Percent patient days <40 mg/dL were 1.03%.
- Percent blood glucoses <54 mg/dL were 0.53%. Percent patient days <40 mg/dL were 1.72%.
- Percent blood glucoses <70 mg/dL were 2.35%. Percent patient days <40 mg/dL were 7.59%.
- Percent blood glucoses >180 mg/dL were 7.19%. Percent patient days <40 mg/dL were 15.17%.
DISCUSSION
eGMS® offers a safe and effective approach to managing IV insulin for labor and delivery patients with diabetes, and results in minimal hypoglycemia. It is an easy-to-use alternative to complex paper-based protocols and can be adopted in busy, high-volume facilities that treat high-risk patients. In the future, it will be desirable to study the impact of eGMS® on incidence of neonatal hypoglycemia requiring admission to the NICU for IV dextrose therapy.
CONCLUSIONS
eGMS® Glucommander™ provided a decreased CCU length of stay of .25 days compared to standard protocols. Patients treated using eGMS® Glucommander™ experienced less overall hypoglycemia than patients treated using standard protocols, and eGMS® Glucommander™ was more effective at reaching ADA targets for average daily blood glucose and final blood glucose.
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