COVID-19 Crisis: Why Now is the Time to Invest in Glycemic Management

In by Andrea Martucci

COVID-19 Crisis: Why Now is the Time to Invest in Glycemic Management

Outcomes for patients with COVID-19 and hyperglycemia: increased mortality, longer length of stay (LOS)

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In the midst of the worldwide novel coronavirus pandemic, emerging data suggests that glycemic control for patients with and without a previous diagnosis of diabetes is a critical component for managing the care of critically ill patients.1 

Early data from a variety of sources identified that patients with diabetes appeared to be at risk for worse outcomes with COVID-192-4, including greater incidence of ending up in the ICU4,5 and an increase in mortality when infected (compared to those without preexisting conditions).2,5-8 

Identifying patients with diabetes as being at high risk for poor outcomes was not surprising, as comorbidities are known to complicate treatment for critically ill patients.9 More data was needed to better understand how COVID-19 specifically impacted patients with glycemic management issues.

Glytec’s recently-released peer-reviewed observational study - the first of its kind - demonstrates that patients hospitalized with COVID-19 who develop acute hyperglycemia, irrespective of diabetes diagnosis, have a higher mortality rate than patients without hyperglycemia.1 

Download the Paper

As an insulin management software company that works with nearly 300 hospitals, Glytec is deeply integrated with electronic medical records systems and leverages live patient data for clinical surveillance to identify patients that may be appropriate for insulin therapy.1

The analysis revealed striking results:1

  • Patients designated as uncontrolled hyperglycemia (but with no apparent history of diabetes) had a mortality rate at 42% compared with the 15% mortality in the population of patients with diabetes. This is a mortality rate seven times higher than the population of patients without diabetes or hyperglycemia (6%).
  • Among the patients who survived to discharge, the combined diabetes and uncontrolled hyperglycemia patient group experienced a significantly longer median length of stay (5.7 days) compared with patients without diabetes or hyperglycemia (4.3 days).

Given this evidence from the study,1 it’s clear that hospitals and health systems should be paying close attention to their patients’ blood sugar and should have a glycemic management strategy in place to treat critically ill patients.

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 minutes 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.

Download the PDF of this Summary Report

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)
    8. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. Published online March 23, 2020. doi:10.1001/jama.2020.4683
    9. Miller AC, Subranian RA, Safi F, Sinert R, Zehtabchi S, Elamin EM. Influenza A 2009 (H1N1) virus in admitted and critically ill patients. J Intensive Care Med. 2011;27:25–31
    10. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2020. American Diabetes Association Diabetes Care Jan 2020, 43 (Supplement 1) S193-S202; DOI:2337/dc20-S015
    11. American Association of Clinical Endocrinologists. AACE.com. https://www.aace.com/disease-state-resources/diabetes/depth-information/management-hyperglycemia-critical-care-setting. Accessed April 9, 2020.
    12. Jacobi et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Critical Care Medicine: December 2012 - Volume 40 - Issue 12 - p 3251-3276 doi: 10.1097/CCM.0b013e3182653269
    13. Ian Blumer, Eran Hadar, David R. Hadden, Lois Jovanovič, Jorge H. Mestman, M. Hassan Murad, Yariv Yogev, Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 11, 1 November 2013, Pages 4227–4249, https://doi.org/10.1210/jc.2013-2465
    14. Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):775–787. doi:10.1001/jama.2016.0289
    15. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486–552. doi:10.1097/CCM.0000000000002255
    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
    17. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. 2009. Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 32(7): 1335‐
    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.
    19. Ian Blumer, Eran Hadar, David R. Hadden, Lois Jovanovič, Jorge H. Mestman, M. Hassan Murad, Yariv Yogev, Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 11, 1 November 2013, Pages 4227–4249, https://doi.org/10.1210/jc.2013-2465
    20. Aloi J. Curr Diab Rep (2019) 19:120 & Rhinehart A, Mabrey M, Garrett V,  Are Hospitals Doing Enough in Caring for Patients with Diabetes, Results of a Nationwide Survey: Current State of Inpatient Diabetes Care & Glycemic Management. Journal of the Endocrine Society, Volume 4 Issue Supplement_1, April-May 2020 
    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
    23. Draznin B, et al. PRIDE Investigators. Pathways to quality inpatient management of hyperglycemia and diabetes: a call to action.Diabetes Care. 2013 Jul;36(7):1807-14.
    24. Glytec Announces Fourth FDA 510(k) Clearance for Its Market-Leading Diabetes Therapy Management Software.https://glytecsystems.com/news/glytec-announces-fourth-fda-510-k-clearance-for-its-market-leading-diabetes-therapy-management-software/
    25. Ullal J. Diabetes Technology Meeting Nov 2017
    26. Newsom R. Journal of Diabetes Science and Technology 2018, Vol. 12(1) 53–59 
    27. Cardona S. Journal of Diabetes and Its Complications 31 (2017) 742–747
    28. Ponnusamy D, Piziak V, Patel S, Urbanosky R. Comparative Effectiveness of a Computerized Algorithm versus a Physician Instituted Protocol to Manage Insulin Infusions after Cardiac Surgery, Clinical Medicine & Research 2014, vol. 12 (1-2) 97. doi: 10.3121/cmr.2014.1250.b2-3
    29. Newsom R, Patty C, Camarena E, Sawyer R, McFarland R, Gray T, Mabrey M. Safely Converting an Entire Academic Medical Center From Sliding Scale to Basal Bolus Insulin via Implementation of the eGlycemic Management System. 2018; Journal of Diabetes Science and Technology.
    30. Aloi J, McFarland R; Reduction of Hospital Hypoglycemia with eGMS and Quality Programming Across 180 US Hospitals.  Accepted for poster presentation at the Hospital Diabetes Meeting, April 24-25, 2020
    31. http://www.diabetesincontrol.com/new-insulin-dosing-software-approved-for-pediatrics/
    32. https://glytecsystems.com/evidence/

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