NEW ORLEANS — Inpatient blood glucose was controlled and hypoglycemia was minimized with the use of a computerized IV insulin administration, according to a presenter here.
“Insulin is one of the most effective but also most dangerous drugs used in the hospital,” Robert J. Tanenberg, MD, FACP, professor of medicine, division of endocrinology at East Carolina University and medical director of Vidant Medical Center Inpatient Diabetes Program in Greenville, North Carolina, told Endocrine Today. “Inpatient hypoglycemia must be avoided or minimized for optimum care of patients with diabetes and stress hyperglycemia. In critically ill medical and surgical patients, IV insulin therapy is mandatory. Paper protocols have performed relatively well, but linear dose adjustments often lead to hyper/hypoglycemic states. In contradistinction, the EndoTool [electronic glycemic management system] uses mathematical modeling and feedback controls and analyzes blood glucose reading trends to develop patient-specific physiologic nonlinear insulin dosing curves based on patient weight, age, diabetes type and glomerular filtration rate.”
Robert J. Tanenberg
Tanenberg and colleagues evaluated the impact of EndoTool (Monarch Medical Technologies), a computer-guided blood glucose management system, in intensive care units at a 900-bed tertiary care teaching hospital. Participants who went on EndoTool had an indication for IV insulin infusion and operative blood glucose levels greater than 140 mg/dL. Time to achieve blood glucose control was evaluated.
Over 7 years, more than 400,000 readings were collected from 16,850 patients. Blood glucose was brought down to 180 mg/dL or lower within 1.5 to 2.3 hours with EndoTool in patients with hyperglycemia. There was minimal hypoglycemia: 0.93% of values were less than 70 mg/dL and 0.03% less than 40 mg/dL. There were year-on-year decreases in hypoglycemia with a significant reduction in frequency, from 1.04% in 2009 to 0.46% in 2015 (P < .0001).
“Until recently, hospitals have been limited to paper-based IV insulin infusion protocol management,” Tanenberg told Endocrine Today. “In the last decade, however, computerized approaches, or Electronic Glycemic Management systems, have become available. Over a 7-year study period, the appropriate use of the EndoTool [electronic glycemic management system] at our 900 bed tertiary care academic medical center led to only 157 glucose values less than 40 mg/dL out of 492,078 readings (0.03%). Notable results included low, cumulative hypoglycemia rates (0.93%) and a significant reduction in year-upon-year hypoglycemia incidence (1.04% in 2009 vs. 0.46% in 2015) even as patient volume more than doubled (from 1,280 patients treated with EndoTool in 2009 to 2,890 in 2015). The use of an [electronic glycemic management system] in a tertiary care hospital resulted in the rapid, effective control of [blood glucose] levels, including significantly reduced hypoglycemia rates.” – by Amber Cox
Tanenberg RJ, et al. 4-LB. Presented at: American Diabetes Association’s Scientific Sessions; June 10-14, 2016; New Orleans.
Disclosure: Tanenberg reports being on the advisory board of Moncarch Medical Technologies.