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

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.

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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.

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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

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Evaluation of the Efficacy and Safety of an eGlycemic Management System in a Community Hospital Setting

Journal of Diabetes Science and Technology ◽

10.1177/1932296820980026 ◽

2020 ◽

pp. 193229682098002

Author(s):

Mary Grace Bouldin ◽

Beatrice Hong ◽

Tracy Setji ◽

James Greenlee ◽

April Cooper ◽

...

Keyword(s):

Blood Glucose ◽

Insulin Therapy ◽

Management System ◽

Community Hospital ◽

Hospital Setting ◽

Efficacy And Safety ◽

Significant Difference ◽

Comparison Cohort ◽

Target Blood Glucose ◽

Basal Bolus

Background: Glucommander is an eGlycemic management system (eGMS) for intravenous (IV) and subcutaneous (SQ) insulin therapy in hospitalized patients. The purpose of this study was to evaluate the efficacy and safety of Glucommander compared to previously utilized nomograms in the community hospital setting. Methods: This study was a retrospective, single-center cohort study comparing measures of efficacy and safety of IV and SQ insulin therapy via eGMS versus nomogram-driven IV insulin therapy followed by provider-ordered basal-bolus SQ insulin. The primary efficacy endpoint was percent of blood glucose (BG) readings per patient in target glycemic range. Safety objectives were percent of hyperglycemic events, hypoglycemic events, and severe hypoglycemic events after achieving target blood glucose range, and mean number of each event per patient. Results: The percentage of BG readings in range was significantly higher for eGMS patients ( n = 110) than comparison cohort patients ( n = 108, 84.6% vs 76.8%, P < .001). Hyperglycemic events occurred for significantly fewer patients in the eGMS cohort relative to the comparison cohort (81.8% vs 92.6%, P = .03). Overall, there was no significant difference between cohorts in rate of hypoglycemic events, but hypoglycemic events while on IV insulin occurred in a significantly higher percentage of eGMS cohort patients than comparison cohort patients (30.9% vs 15.7%, P < .01). There were no significant differences in incidence of severe hypoglycemic events. Conclusions: Our study found that Glucommander maintained a higher percentage of BG readings in target BG range per patient compared to previously utilized nomograms. This result was driven by an improvement in hyperglycemia, but not hypoglycemia.

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Basal-Bolus Insulin Therapy May Not Be the Optimal Strategy in a "Real-World" Hospital Setting for Inpatient Hyperglycemia Management

Diabetes ◽

10.2337/db18-1256-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1256-P

Author(s):

ARCHANA R. SADHU ◽

BHARGAVI PATHAM ◽

AISHA VADHARIYA ◽

MICHAEL L. JOHNSON

Keyword(s):

Insulin Therapy ◽

Real World ◽

Optimal Strategy ◽

Hospital Setting ◽

Bolus Insulin ◽

Basal Bolus

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Inpatient hyperglycemia management: the opportunities of a new basal insulin

Italian Journal of Medicine ◽

10.4081/itjm.2016.681 ◽

2016 ◽

Vol 10 (2) ◽

pp. 103 ◽

Cited By ~ 3

Author(s):

Natalino Simioni

Keyword(s):

Insulin Therapy ◽

Basal Insulin ◽

Hospital Setting ◽

Insulin Analogues ◽

Diabetic Patients ◽

Potential Clinical Benefit ◽

Sliding Scale ◽

Bolus Insulin ◽

Basal Bolus

The management of hospitalized diabetic patients for any cause is often difficult and affected not only by the comorbidities of the patient but also by the hospital setting. It is well known that at the admission the antidiabetic drugs should be discontinued on behalf of insulin therapy with insulin analogues, as a function of a basal-bolus insulin approach according to the phenotype of the patient, type of nutrition (enteral or parenteral rather than oral), or concomitant hyperglycemic therapy (<em>e.g.</em>, steroid). The average stay of diabetic patients hospitalized for any cause is significantly correlated with both the number of hypoglycemia and hyperglycemia. Compared to patients treated with sliding scale patients using a custom algorithm show a significant reduction in the number of hypoglycemia and hyperglycemia episodes and in the length of stay. We analyze the clinical profile of a novel basal insulin, degludec, and explore the potential clinical benefit for diabetic inpatient. The continuation of insulin therapy at home in the immediate post-hospitalization (if necessary), also correlates with a reduction in the rate of re-hospitalization, which combined with close follow-up diabetes can result in a reduction of chronic complications.

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