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Introduction
Dr. Priyathama Vellanki hates needlessly high costs.
Too many times, the Associate Professor, Division of Endocrinology, Metabolism & Lipids at Emory University School of Medicine has seen how exorbitant healthcare costs negatively impact medical facilities and their patients — it’s enough to make a person sick.
And while some are happy to accept the status quo at any cost, Dr. Vellanki consistently directs the focus of her research on driving down costs in ways that maintain or improve patient outcomes. And with the advent of new technology, there’s no shortage of spaces to investigate.
One that recently caught her eye was the glycemic management of CABG patients. The vast majority of cited research pre-dates the advent of eGlycemic Management System® (eGMS) technology, and is predicated on a cost-benefit analysis that heavily weighs the risk of hypoglycemia. But with algorithm-driven dosing support and safety guardrails, Dr. Vellanki hypothesized that the risk of hypoglycemia could be all but eliminated leaving her with the opportunity to test for a truly optimal target range.
To test her hypothesis, Dr. Vellanki designed a GLUCO-CABG study and cost analysis that looked at Grady Memorial patients who had undergone coronary artery bypass grafting (CABG) surgery. Her methodology relied on Glytec’s Glucommander™ as the insulin dosing software at the heart of eGMS, and she felt strongly that her hypothesis would be proven right. But only time would tell.
| Established in 1892, Grady Memorial Hospital is a public, 400-bed teaching hospital that works closely with Emory University School of Medicine and other nearby medical schools in downtown Atlanta. Day in and day out, they prioritize affordable healthcare without ever compromising their status as innovative leaders in the field. Never afraid to challenge the status quo and with a belief that available technology should be leveraged to its fullest extent, Dr. Vellanki set out to see if she could improve upon the long-established standard of care for CABG surgeries. |
The Problem
It’s commonly understood that control of hyperglycemia is crucial for patients with and without diabetes in all areas of the hospital, but what’s less known is how prevalent it can be – afflicting 70% of patients with diabetes, and 30% of patients without.
This is not only dangerous, but can get expensive quickly for both patients and healthcare systems – a cost that’s felt acutely in public hospitals like Grady. But fortunately, Grady has prioritized the implementation of innovative technology over the years, and thanks to their status as a teaching hospital has built-in access to thought-leaders and their groundbreaking research.
Dr. Vellanki is one of those leaders, and regularly investigates whether or not costs can be cut without compromising patient outcomes. Her latest research question – whether intensive glycemic control can slash expenses while maintaining or potentially even improving CABG patient outcomes – has many very excited at the possibilities.
Although a past study in Belgium by Greet Van den Berghe demonstrated that intensive control — glucose ranges from 80-110 mg/dL — in the ICU decreases complications, subsequent studies have so far been unable to replicate that result. In fact, the large-scale 2009 NICE-SUGAR study found that patients with intensive control (81-108 mg/dL) had higher mortality risks due to hypoglycemia (1.5x higher in those with moderate hypoglycemia and 3x higher in those with severe hypoglycemia).
Recognizing that technology has advanced our ability to manage hypoglycemia, and feeling that the existing research was inconclusive Dr. Vellanki decided to conduct her own study to determine whether intensive or conventional control was optimal in terms of resource utilization, length of stay and rate of complications.