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Insulin management system effective for diabetic ketoacidosis in ED
Patients with mild to moderate diabetic ketoacidosis admitted to the ED may be successfully treated with intensive insulin therapy, leading to lower admission and future admission rates as well as significant cost savings, study data indicate.
The researchers used the Glucommander IV (Glytec) for guiding the insulin treatment.
“Our results indicate that Glucommander IV it a safe and efficient tool for use in the ED to manage mild to moderate [diabetic ketoacidosis],” Jagdeesh Ullal, MD, an endocrinology specialist at Eastern Virginia Medical School in Norfolk, said in a press release. “These findings are significant since they suggest that the Glucommander IV could potentially help EDs with high patient volumes to effectively determine those patients who might require hospital admission vs. those that can be maintained under observation status or those who can be discharged home.”
Ullal and colleagues evaluated 35 patients who visited the ED with hyperglycemic crisis and were diagnosed with diabetic ketoacidosis (DKA) during 1 year to determine the effectiveness of the Glucommander in the ED.
Sixteen participants were discharged home and 19 were admitted. Between the two groups, significant differences were found in the anion gap (P = .002) and the serum bicarbonate level (P = .006); researchers noted that participants with higher anion gap and low bicarbonate levels were more likely to be admitted.
Target blood glucose was reached in 5 hours and 11 minutes with a mean glucose of 145 mg/dL in participants using the Glucommander. No glucose events of more than 250 mg/dL were recorded after participants reached the target, and there were no episodes of hypoglycemia less than 40 mg/dL; 18 events of less than 70 mg/dL occurred. The Glucommander was used for 14 hours before being discontinued or the participants were transferred out of the ED. Only one participant who used the Glucommander was readmitted to the ED in a 30-day interval.
“Glucommander management of insulin infusion in treatment of DKA in the ED setting was safe and effective at resolving the metabolic abnormalities in an efficient manner,” the researchers wrote. “Analysis of our data presents a novel mechanism to stratify patients requiring hospital admission vs. home disposition. Results from our experience suggest that use of a computer-based insulin infusion algorithm in the ED can decrease admissions to the hospital for DKA by approximately 45%. The rate of readmission of mild DKA patients was minimal, supporting the effectiveness and appropriateness of ED management of mild DKA.” – by Amber Cox
Disclosure: One of the researchers is an employee of Glytec.