This study’s results reinforces our knowledge that for many conditions like sepsis, coronary disease, pneumonia, stroke and the critically ill, hyperglycemia on admission is a marker for worse outcomes,38-39,41,44,45 and good glycemic management during the hospital stay leads to better outcomes.46-48

So, while it’s not surprising given what is already known about the importance of glycemic management, this research is important for establishing best practices for COVID-19 patient care.

 

Best Practice for Inpatient Glycemic Management

 

“This research confirms that diabetes is an important risk factor for dying from COVID-19. It also suggests that patients with acutely uncontrolled hyperglycemia – with or without a diabetes diagnosis – are dying at a higher rate than clinicians and hospitals may recognize. It is paramount that we treat hyperglycemia in COVID-19 patients as directed by national guidelines, with subcutaneous basal-bolus insulin in most non-critically ill patients, and with IV insulin in the critically ill.”1

Current recommendations for inpatient insulin management, from the American Diabetes Association’s Standards of Medical Care in Diabetes 2020:1

  • Continuous IV Insulin is the most effective method to reach glycemic targets
  • Insulin infusions should be administered with valid written or computerized protocols that: 
    • Allow adjustments in infusion rate
    • Account for glycemic fluctuations
    • Account for insulin dose target

The ADA’s recommendations are echoed by other professional organizations dedicated to improving glycemic management, including the American Association of Clinical Endocrinologists,11 The Society of Critical Care Medicine,12 and Endocrine Society,13 among many others.14-19

Despite these recommendations, about 90% of doctors, practitioners and nurses rely on one-size-fits-all, simplistic, insulin protocols (sliding scale) and “pocket-cards” to aid in deciding appropriate insulin doses for hospitalized patients.20 For years this approach has been error-prone, difficult to scale, and is not able to be individualized for each patient.21

Change management may be difficult, but even before COVID-19 increased the number of critically ill patients in hospitals, up to one-third of all hospital patients experience glycemic issues due to diabetes, drug reactions, stress and other factors.22,23 Glycemic management improvements have the potential to help a large number of patients.

 

What action can you take NOW to improve your hospital’s glycemic management strategy

 

Glytec is the insulin management software company for healthcare providers focused on improving the quality and cost of care. Its FDA-cleared titration software24 and proprietary algorithms power Glucommander, the only solution capable of delivering personalized diabetes treatment recommendations across the continuum of care, from hospital to home.25

 

Quality and Safety


Glytec’s solutions have served to reduce severe hypoglycemia by as much as 99.8%, 30-day readmissions by 36% to 68% and lengths of stay by up to 3.2 days.25-27

Glucommander reduces time to target blood glucose by 10 hours over standard care -- the average time to target blood glucose under standard care is 14.9 hours, compared to 4.9 hours with Glucommander.28

 

Cost Savings

Within the hospital setting, studies have shown enterprise-wide utilization of Glucommander at, or above, 95% of eligible patients and annualized cost savings as high as $20,000 per licensed bed.26,29

 

Comorbid Condition Readmission Rate Improvements

Glycemic control using Glytec’s Glucommander can effectively reduce the rate of readmission for patients with cardiovascular disease who are in need of insulin management. In one study, AMI, CHF, and CABG patients (respectively) saw a 36%, 65%, and 68% reduction in 30-day readmission rates when they were treated with eGMS (Glucommander) compared to standard care.9

 

Nursing Time Savings


Our solution simplifies workflows for clinicians and nurses, enabling them to deliver better care and spend more time with patients.29

Prescribers saved an average of 199.5 seconds with each patient over the course of their stay, and saved on average 30 minutes per shift by using computer-guided decision support rather than manually titrating daily basal bolus insulin.29

 

FDA-Cleared and Used in Nearly 300 Hospitals

Glytec is used in nearly 300 hospitals and healthcare facilities and was used in treating 150,000 patients in 2019 alone.30

Glucommander, powered by Glytec, has been proven effective over 14 years of use and was the first insulin titration software to be cleared by the FDA for adult IV use.31 Glucommander has 4 FDA clearances24 and 70+ studies showing efficacy.32

 

Work with Glytec

With ongoing support from its team of doctors, nurses and technologists headquartered outside of Boston, Glytec improves outcomes and controls costs for the large population of patients requiring insulin treatment – including those with and without a diagnosis of diabetes. 

It's now faster and easier than ever to install Glucommander in your facility - Glytec offers expedited and fully remote implementation.

We’d love to discuss how Glytec can help your team - reach out to discuss your needs or request a demo.

 

References:

    1. Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, Klonoff DC. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol. 2020; In press.
    2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648.
    3. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published online ahead of print, 2020 Mar 3]. Intensive Care Med. 2020;1–3. doi:10.1007/s00134-020-05991-.
    4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30;:]. Lancet. 2020;395(10223):497–506. doi:10.1016/S0140-6736(20)30183-5
    5. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China [published online ahead of print, 2020 Feb 28]. N Engl J Med. 2020;0:NEJMoa2002032. doi:10.1056/NEJMoa2002032
    6. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054–1062. doi:10.1016/S0140-6736(20)30566-3)
    7. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? [published online ahead of print, 2020 Mar 11]. Lancet Respir Med. 2020;S2213-2600(20)30116-8. doi:10.1016/S2213-2600(20)30116-8)
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    16. Gosmanov AR, Gosmanova EO, Dillard-Cannon E. Management of adult diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2014;7:255–264. Published 2014 Jun 30. doi:10.2147/DMSO.S50516
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    18. Lazar et al. The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery.Ann Thorac Surg. 2009 Feb;87(2):663-9. doi: 10.1016/j.athoracsur.2008.11.011.
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    21. Browning LA, Dumo P. Sliding-scale insulin: an antiquated approach to glycemic control in hospitalized patients. Am J Health Syst Pharm. 2004;61(15):1611–1614. doi:10.1093/ajhp/61.15.1611
    22. Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) 2015. Nov 2017
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