Knowledge Translation to Optimize Adult Inpatient Glycemic Management With Basal Bolus Insulin Therapy and Improve Patient Outcomes

Background: American Diabetes Association (ADA) guidelines recommend a basal bolus correction insulin regimen as the preferred method of treatment for non–critically ill hospitalized patients. However, achieving ADA glucose targets safely, without hypoglycemia, is challenging. In this study we evaluated the safety and efficacy of basal bolus subcutaneous (SubQ) insulin therapy managed by providers compared to a nurse-directed Electronic Glycemic Management System (eGMS). Method: This retrospective crossover study evaluated 993 non-ICU patients treated with subcutaneous basal bolus insulin therapy managed by a provider compared to an eGMS. Analysis compared therapy outcomes before Glucommander (BGM), during Glucommander (DGM), and after Glucommander (AGM) for all patients. The blood glucose (BG) target was set at 140-180 mg/dL for all groups. The safety of each was evaluated by the following: (1) BG averages, (2) hypoglycemic events <40 and <70 mg/dL, and (3) percentage of BG in target. Result: Percentage of BG in target was BGM 47%, DGM 62%, and AGM 36%. Patients’ BGM BG average was 195 mg/dL, DGM BG average was 169 mg/dL, and AGM BG average was 174 mg/dL. Percentage of hypoglycemic events <70 mg/dL was 2.6% BGM, 1.9% DGM, and 2.8% AGM treatment. Conclusion: Patients using eGMS in the DGM group achieved improved glycemic control with lower incidence of hypoglycemia (<40 mg/dL and <70 mg/dl) compared to both BGM and AGM management with standard treatment. These results suggest that an eGMS can safely maintain glucose control with less hypoglycemia than basal bolus treatment managed by a provider.

Download Full-text

BASAL-BOLUS INSULIN THERAPY FOR INPATIENT GLYCEMIC MANAGEMENT: BEYOND GLYCEMIC CONTROL–WHERE DO WE GO FROM HERE?

Endocrine Practice ◽

10.4158/ep-2019-0223 ◽

2019 ◽

Vol 25 (9) ◽

pp. 971-973

Author(s):

Michelle F. Magee ◽

Alex R. Montero

Keyword(s):

Glycemic Control ◽

Insulin Therapy ◽

Bolus Insulin ◽

Basal Bolus ◽

Glycemic Management

Download Full-text

Analysis of “Comparison an Electronic Glycemic Management System Versus Provider Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting”

Journal of Diabetes Science and Technology ◽

10.1177/1932296816677296 ◽

2016 ◽

Vol 11 (1) ◽

pp. 17-19

Author(s):

Silvia Leitgeb ◽

Julia K. Mader

Keyword(s):

Blood Glucose ◽

Glycemic Control ◽

Insulin Therapy ◽

Management System ◽

Positive Impact ◽

Hospital Setting ◽

Before And After ◽

Bolus Insulin ◽

Basal Bolus ◽

Glycemic Management

Safety and efficacy of a nurse-directed electronic glycemic management system (eGMS) in comparison to basal-bolus subcutaneous insulin therapy managed by providers has been evaluated recently by Aloi et al. They included 993 non–critically ill patients across 9 different hospitals in a retrospective observational crossover study and compared mean blood glucose, number of hypoglycemic events <40 mg/dl and <70 mg/dl and the percentage of blood glucose in target (140-180 mg/dl) before, during and after the use of eGMS. Conclusion was that eGMS can lead to better glycemic control with less hypoglycemic events compared to provider managed basal-bolus insulin therapy (before and after eGMS). Although some limitations exist, the authors made a strong case that eGMS has positive impact on glycemic control in hospitalized patients with diabetes.

Download Full-text