JULY 8, 2016
Reduced Inpatient Hypoglycemia With Electronic Glycemic Management System
An electronic glycemic management system (eGMS) may help lower rates of hypoglycemia and lower average blood glucose levels in hospitalized patients compared with usual care, according to a new study.
Researchers, who presented the findings at the American Association of Clinical Endocrinologists (AACE) 25th Annual Scientific & Clinical Congress, reported that the use of eGMS could potentially improve patient outcomes and prevent longer hospital stays.
“It is clinically meaningful and clinically important,” said study investigator Joseph Aloi, MD, professor of medicine and the chief of endocrinology and metabolism at Wake Forest School of Medicine, Winston-Salem, North Carolina. “I have been looking at this issue for 10 years, and I think the real surprise was how dramatic the drop was.”
The aim of this study was to compare hypoglycemia rates in patients managed with an eGMS compared with patients managed by usual care. In this current study, there were 45,335 patients treated with usual care and 13,351 patients treated with eGMS. The target blood glucose was pegged at 100 mg/dL to 180 mg/dL. The researchers evaluated how many patients experiencing mild to moderate hypoglycemia (<70 mg/dL, <60 mg/dL, and <50 mg/dL) and severe hypoglycemia (<40 mg/dL) in the eGMS group compared with the usual care group. In both groups, researchers were able to compare hospital admission blood glucose levels and mean blood glucose levels.
The researchers found that the incidence of patients experiencing any hypoglycemia (blood glucose <70 mg/dL) was 13.8% for those who were in the eGMS group compared with 21.7% for those in the usual care group. Among those in the eGMS group, 6% had blood glucose <60 mg/dL and 2.5% blood glucose < 50 mg/dL compared with 13.7% (<60 mg/dL) and 7.7% (<50 mg/dL) in the usual care group.
The eGMS group also had less severe hypoglycemia (0.9% of patients with a blood glucose <40 mg/dL) compared with the usual care group (3.6% of patients with a blood glucose <40 mg/dL). The average blood glucose for patients treated with eGMS was 178 mg/dL compared with 188 mg/dL for those in the usual care group.
“At the end of the day, the electronic computer platforms provide less hypoglycemia, which translates into better outcomes and decreased length of stay for one,” said Dr Aloi.
He said hypoglycemia is a common adverse event for patients treated with insulin in the hospital setting, and known risk factors include renal insufficiency, poor nutritional intake, or prior hypoglycemia. These factors are incorporated into the eGMS insulin dosing algorithm, and this may provide important benefits.
Dr Aloi said the benefits of eGMS IV and SubQ insulin algorithms, which were examined in this current study, include patient-specific insulin dosing that calculates a patient’s insulin sensitivity. He noted that the SubQ algorithms have additional benefits of matching insulin to carbohydrate intake for patients with poor nutritional intake during hospitalization.
“Other important points are the ease of titration and avoiding therapeutic inertias as well as ability to treat carbs directly with insulin,” said Dr Aloi. “It helps prevent clinical misjudgment. It may help prevent overtreatment.”
For critically ill patients, hypoglycemia is thought to be a biomarker of severity of disease, the researchers noted. However, they contend that some percentage of these hypoglycemic events is preventable. Dr Aloi said prospective studies are warranted to assess if preventing hypoglycemic events with eGMS can lower overall health care costs and improve patient outcomes compared to the current standard of care.
- Aloi J, Ullal J, Chidester P, et al. Abstract 1306. Improved Inpatient Hypoglycemia Rates With Electronic Glycemic Management System. Presented at: AACE 25th Annual Scientific & Clinical Congress; May 25-29, 2016; Orlando, FL.