Software-Guided Insulin Dosing: Tight Glycemic Control and Decreased Glycemic Derangements in Critically Ill Patients

Saur, Nicole M.; Kongable, Gail L.; Holewinski, Sharon; O’Brien, Keri; Nasraway, Stanley A.

doi:10.1016/j.mayocp.2013.07.003

Cited by 31 publications

(24 citation statements)

References 54 publications

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“…However, it has been difficult to determine what factors are responsible for this superiority. Recent evidence indicates that, compared with paper-based protocols, software-driven IV insulin administration more effectively manages the 3 pivotal domains of glucose control (hyperglycemia, hypoglycemia, and GV) (23,27,39). These 3 BG parameters are all independently associated with higher in-hospital mortality rates and length of stay,(2,7,8) and have all been shown to improve with eGMS compared with paper-based protocols, both in previous studies(23,25,26,28,39) and the current analysis.…”

supporting

confidence: 52%

See 1 more Smart Citation

Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year, Retrospective Observational Study at A Tertiary Care Teaching Hospital

et al. 2017

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supporting

confidence: 52%

“…These results placed VMC in the top 10% of all U.S. hospitals for HAC-8 compliance (38). Research has documented the improved performance of eGMS systems compared with paper algorithms (23)(24)(25)(27)(28)(29)31,39). However, it has been difficult to determine what factors are responsible for this superiority.…”

mentioning

confidence: 99%

Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year, Retrospective Observational Study at A Tertiary Care Teaching Hospital

et al. 2017

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“…Saur et al 39. described that surgical ICU patients who were managed using a software‐guided program achieved tighter glycemic control and fewer glycemic derangements than those managed with the paper‐based insulin dosing regimen.…”

Section: Insulin Therapy In Patients With Perioperative Hyperglycemiamentioning

confidence: 99%

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Takesue

Tsuchida

2017

Annals of Gastroent Surgery

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Perioperative hyperglycemia is a risk factor for surgical site infections (SSI). Although the recommended target blood glucose level (BG) is 140–180 mg/dL for critically ill patients, recent studies conducted in patients undergoing surgery showed a significant benefit of intensive insulin therapy for the management of perioperative hyperglycemia. The aim of the present review is to evaluate the benefits of strict glycemic control for reducing SSI in gastroenterological surgery. We carried out a post‐hoc analysis of the previously published data from research on the risk factors for SSI. The highest BG within 24 hours after surgery was evaluated. A total of 1555 patients were enrolled in the study. In multivariate analysis, a dose–response relationship between the level of hyperglycemia and the odds of SSI was demonstrated when compared with the reference group (≤150 mg/dL) (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.14–2.49 for 150–200 mg/dL; and OR = 2.15, 95% CI 1.40–3.29 for >200 mg/dL). Unexpectedly, hyperglycemia was not a significant risk factor for SSI among diabetes patients. By contrast, non‐diabetes patients with a BG of >150 mg/dL were found to have increased odds of SSI. In conclusion, a target BG of ≤150 mg/dL is recommended in patients without diabetes who undergo gastroenterological surgery. Additional study is required to determine an optimal target BG in diabetes patients. Because of the risk of hypoglycemia, a conventional protocol is indicated for patients admitted to the general ward where frequent glucose measurement is not assured.

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“…Compare to these results the performance of the SGC in our study has shown somewhat superior efficiency with time in target range 83 % and also the safety with hypoglycaemia only 0.2 % of all measurements. Previous may also apply for other potential head-to-head comparisons with latest insulin protocol studies with similar target range: Software-guided insulin dosing protocol used by Saur and colleagues maintained glycaemia 68 % of time in the target range 5.3 -7.5 mmol/l with hypoglycaemia of 0.5 % [ 26 ]. SPRINT (Specialized Relative Insulin and Nutrition Tables) protocol, used at Hungarian ICU, achieved 77.6 % of BG measurements in the target range 4.0-8.0 mmol/l with 1.9 % of the BG <4.0 mmol/l [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Space GlucoseControl system for blood glucose control in intensive care patients - a European multicentre observational study

et al. 2015

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BackgroundGlycaemia control (GC) remains an important therapeutic goal in critically ill patients. The enhanced Model Predictive Control (eMPC) algorithm, which models the behaviour of blood glucose (BG) and insulin sensitivity in individual ICU patients with variable blood samples, is an effective, clinically proven computer based protocol successfully tested at multiple institutions on medical and surgical patients with different nutritional protocols. eMPC has been integrated into the B.Braun Space GlucoseControl system (SGC), which allows direct data communication between pumps and microprocessor. The present study was undertaken to assess the clinical performance and safety of the SGC for glycaemia control in critically ill patients under routine conditions in different ICU settings and with various nutritional protocols.MethodsThe study endpoints were the percentage of time the BG was within the target range 4.4 – 8.3 mmol.l−1, the frequency of hypoglycaemic episodes, adherence to the advice of the SGC and BG measurement intervals. BG was monitored, and insulin was given as a continuous infusion according to the advice of the SGC. Nutritional management (enteral, parenteral or both) was carried out at the discretion of each centre.Results17 centres from 9 European countries included a total of 508 patients, the median study time was 2.9 (1.9-6.1) days. The median (IQR) time–in–target was 83.0 (68.7-93.1) % of time with the mean proposed measurement interval 2.0 ± 0.5 hours. 99.6 % of the SGC advices on insulin infusion rate were accepted by the user. Only 4 episodes (0.01 % of all BG measurements) of severe hypoglycaemia <2.2 mmol.l−1 in 4 patients occurred (0.8 %; 95 % CI 0.02-1.6 %).ConclusionUnder routine conditions and under different nutritional protocols the Space GlucoseControl system with integrated eMPC algorithm has exhibited its suitability for glycaemia control in critically ill patients.Trial registrationClinicalTrials.gov NCT01523665

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Software-Guided Insulin Dosing: Tight Glycemic Control and Decreased Glycemic Derangements in Critically Ill Patients

Cited by 31 publications

References 54 publications

Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year, Retrospective Observational Study at A Tertiary Care Teaching Hospital

Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year, Retrospective Observational Study at A Tertiary Care Teaching Hospital

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Space GlucoseControl system for blood glucose control in intensive care patients - a European multicentre observational study

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