International Hospital Diabetes Meeting
Melanie Mabrey, Joseph Aloi, Paul Chidester, Jagdeesh Ullal, Amy Henderson, Raymie McFarland, Robby Booth
American Diabetes Association guidelines recommend a basal bolus correction insulin regimen as the preferred method of treatment for non-critically ill hospitalized patients. The target for premeal blood glucose (BG) of <140 mg/dL and random BG of <180 mg/dL are well defined. However, achieving these targets safely, without hypoglycemia, is challenging. With this study we evaluated glycemic control with fasting and pre-prandial BGs for patients using Glucommander Subcutaneous (GM SubQ) treatment for insulin therapy.
769 patients treated with GM SubQ insulin therapy were evaluated. Qualifying patients had two BGs >180 mg/dL in 24 hours and required insulin. The target glucose was set at 100-140 mg/dL fasting and pre-prandial. The safety and efficacy was evaluated at the following time points: before each meal (breakfast, lunch, dinner) and at bedtime via (1) BG averages, (2) BG reductions, and (3) hypoglycemic events <70 mg/dL and <40 mg/dL.
Patients treated on GM SubQ achieved an average pre-prandial BG at breakfast of 119 mg/dL, lunch 131 mg/dL, dinner 126 mg/dL and bedtime of 116 mg/dL. Initial BG average was 227 mg/dL. BG average over length of stay was 132 mg/dL.
Reduction of BG at breakfast was 84 mg/dL, lunch 106 mg/dL, dinner 100 mg/dL, and bedtime 105 mg/dL. Average BG reduction was 98.75 mg/dL. Hypoglycemia <70 mg/dL at breakfast was 2.3%, lunch 1.9%, dinner 3.0% and bedtime 2.0%. Hypoglycemia <40 mg/dL at breakfast was 0.0%, lunch 0.1%, dinner 0.1% and bedtime 0.1%.
|Initial BG Average||227 mg/dL|
|Glucommander BG Average||132 mg/dL|
|Hypoglycemia <70 mg/dL – Breakfast||2.3%|
|Hypoglycemia <70 mg/dL – Lunch||1.9%|
|Hypoglycemia <70 mg/dL – Dinner||3.0%|
|Hypoglycemia <70 mg/dL – Bedtime||2.0%|
|Hypoglycemia <40 mg/dL – Breakfast||0.0%|
|Hypoglycemia <40 mg/dL – Lunch||0.1%|
|Hypoglycemia <40 mg/dL – Dinner||0.1%|
|Hypoglycemia <40 mg/dL – Bedtime||0.1%|
Patients using GM SubQ achieved prescribed glycemic target at each meal and bedtime with low incidence of hypoglycemia (<70 mg/dL & <40 mg/dL). These results suggest GM SubQ can maintain glucose control in ADA recommended targets without increased risk of hypoglycemia.