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Electronic management systems improve glucose control in hospitalized patients
Computer-guided glucose management systems quickly and effectively controlled blood glucose levels among hospitalized patients who experienced hyperglycemia, according to findings published in Endocrine Practice.
“Until recently, hospitals were limited to paper-based IV insulin infusion protocol management. In the last decade, however, computerized approaches, known as electronic glycemic management systems, have become available,” Robert J. Tanenberg, MD, FACP, medical director of the Diabetes and Obesity Institute at East Carolina University in Greenville, North Carolina, and colleagues wrote. “The past decade has seen substantial research to describe the performance of computer-programmed protocols, and a series of controlled studies have found significantly improved [blood glucose] control with [electronic glycemic management systems] vs. paper-based protocols.”
Researchers obtained 492,078 blood glucose readings from 16,850 patients at Vidant Medical Center in Greenville, North Carolina, who were assigned to an electronic glucose management system (EndoTool, Monarch Medical Technologies) for a 7-year period (mean, 29 readings per patient). All the patients had indications for IV insulin infusion, including postoperative blood glucose concentrations greater than 140 mg/dL, uncontrolled diabetes and stress hyperglycemia. Tanenberg and colleagues evaluated the time to glucose control, glucose variability and excursions, impact of the management system on hospital-acquired condition-8 (HAC-8) rates and hypoglycemia incidence.
The electronic management systems brought blood glucose to target levels within 1.5 to 2.3 hours for noncardiovascular patients and 4.5 to 4.8 hours for CV patients, the researchers reported. Tanenberg and colleagues observed “minimal” hypoglycemia (blood glucose values < 70 mg/dL, 0.93%; < 40 mg/dL, 0.03%). Four percent of patients experienced glucose excursions (> 180 mg/dL), the researchers wrote. HAC-8 rates fell from 0.083 incidents per 1,000 patients in 2008 to 0.032 incidents per 1,000 patients in 2011.
“[Vidant Medical Center’s] use of the [electronic glucose management system] to administer IV insulin in the ICUs and [intermediate units] in the setting of a large tertiary care hospital resulted in significant improvements in overall glucose control, assessed as hyperglycemia, hypoglycemia and glucose excursions,” the researchers wrote. “It is likely that other facilities could achieve similar improvements in [blood glucose] control and patient outcomes using the EndoTool [electronic glucose management system].” – by Andy Polhamus
Disclosure: Tanenberg is an advisory board member for Monarch Medical Technologies. Monarch provided grant funding for this study, but did not oversee study design, data selection or analysis. No other researchers report relevant financial disclosures.