Joseph Aloi, MD, director of the Strelitz Diabetes Center at Eastern Virginia Medical School in Norfolk, and colleagues reported in a study that patients monitored with the Glucommander system reduced episodes of hypoglycemia by 56%.
In a second study, they showed that the same system reduced the overall hospital length of stay by nearly 2 1/2 days in patients with diabetic ketoacidosis.
Dr. Aloi added that, "Having an algorithm sitting in the electronic medical record seems to have improved both problems by prompting providers to ‘do the right thing’."
Given ongoing efforts to improve the quality of care, and as reimbursement shifts towards pay-for-performance models, there has been greater emphasis on hitting nationally standardized blood glucose metrics. More clinicians are adopting electronic health records (EHR) systems, and some companies have developed algorithms to interface with those systems for better monitoring of care.
Aloi said hypoglycemia is associated with increased mortality and costs in the hospital, but it’s not managed well in the hospital setting. Although the EHR generates great data, it’s not all used efficiently, and there are still gaps in care, he said.
So his team incorporated the web-based algorithm Glucommander into the hospital EHR to look at inpatient insulin protocols over 30 days at two hospitals within Sentara Healthcare System in southeast Virginia. They also assessed hypoglycemia 30 days prior to being monitored with the system. They found that baseline hypoglycemia episodes were reduced by 56% with the algorithm compared with standard basal bolus insulin care.
There was also a greater reduction in blood glucose levels in the monitored group, where glucose levels fell by a mean of 30% (from 233 to 163 mg/dL) compared with just 15% in the standard care group (from 215 to 184 mg/dL).
The researchers concluded that the findings "support that [the algorithm] is a safe and clinically effective tool for improving glycemic control for patients who need subcutaneous insulin treatment while in the hospital."
In a second study, the team looked at Glucommander monitoring of patients with mild to moderate diabetic ketoacidosis, reviewing the care of 168 patients from three community hospitals over a 3-month period. Patients were split into two groups: those who were appropriately discontinued from electronic glucose monitoring, and those who were prematurely discontinued from monitoring.
Overall, there were no significant differences in glucose levels at discharge between the two groups, and all patients achieved target glucose. Although hypoglycemia was low in both groups, there was an increase once electronic monitoring was discontinued, with more patients hitting 40 mg/dL in the prematurely withdrawn group (0.9% versus 0.1%).
But the main difference, Aloi said, was in length of stay which was reduced by 2.4 days for those constantly monitored (5.33 days versus 7.7 days).
He concluded that the technology improved patient safety by reducing the incidence of hypoglycemia in patients with DKA, while bringing all patients into target glycemic range and lowering overall length of stay.
- Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- The use of a web-based insulin algorithm integrated with the hospital’s electronic health record appeared to be clinically effective, reducing hypoglycemic episodes in hospital patients receiving subQ insulin.
American Association of Clinical Endocrinologists; Source reference: Aloi J, et al "Sentara Health System sees glycemic improvements for hospital basal bolus patients using e-glycemic management system" AACE 2014; Abstract 1994399.