Safety and Efficacy of eGlycemic Management System® among Labor and Delivery Patients at a Not-for-Profit Hospital in Hawaii Venkataraman Balaraman, MD, MBBS | Pushpa Rayasam, BS | Raymie McFarland, PT, SSBB

BACKGROUND METHODS The American College of and Gynecology This retrospective quality improvement study examined rates of moderate <70 mg/dL, recommends tight glycemic control (blood glucose <110 mg/dL) severe hypoglycemia <54 mg/dL and extreme hypoglycemia <40 mg/dL as primary outcomes as well during labor and delivery in patients with type 1, type 2 and as moderate >180 mg/dL and median time to target (80-120 mg/dL) as secondary gestational diabetes to minimize risk of neonatal hypoglycemia. outcomes. Included in the study were patients admitted to a not-for-profit tertiary birthing facility in Inherently, this targeted treatment can be associated with Honolulu, Hawaii from November 2015 through June 2018 who were managed using eGMS®. higher risk of complications, especially hypoglycemia in the mother as she is already in a potentially ketotic state.

RESULTS Average BG (mg/dL) on IV Insulin with eGMS®

® OBJECTIVE Glycemic Outcomes with eGMS 210 190 Target BG (80-120 mg/dL) ® The objective of this study was to evaluate if the Glytec Percent Blood Glucoses 170 eGlycemic Management System® (eGMS®) safely supports 15.17% 150 Percent Patient Days 130 tight glycemic control, with minimal episodes of hypoglycemia, 110 among labor and delivery patients with diabetes who receive 90 antepartum and intrapartum intravenous (IV) insulin . 70 50 1:00 7:00 0:00 2:00 3:00 5:00 8:00 6:00 9:00 4:00 11:00 17:00 10:00 12:00 13:00 15:00 18:00 21:00 16:00 19:00 14:00 20:00 22:00 23:00 24:00

7.59% 7.19% Average IV Insulin Infusion Rate (units/hr) with eGMS®

DEMOGRAPHIC VARIABLES Value SD 15

Number of Patients 204 10 5 2.35% Average Age (years) 29 1.72% 0 1.03% 0.53% -5 0.14% Average A1C (%) (n=92) 7.16 -10 1:00 7:00 0:00 2:00 3:00 5:00 8:00 6:00 9:00 4:00 11:00 17:00 10:00 12:00 13:00 15:00 18:00 21:00 16:00 19:00 14:00 20:00 22:00 23:00 <40 mg/dL <54 mg/dL <70 mg/dL >180 mg/dL 24:00 Average Height (cm) 161

Average Weight (kg) 94.30

Average Initial BG (mg/dL) 152 51.44

Average Final BG (mg/dL) 113 32.77 DISCUSSION CONCLUSION There is limited information in eGMS® offers a safe and effective approach to Average of all BGs First Day (mg/dL) 128 43.94 the literature regarding rate of managing IV insulin for labor and delivery patients Average of all BGs Last Day (mg/dL) 117 31.33 complications with aggressive glycemic with diabetes, and results in minimal hypoglycemia. control among labor and delivery It is an easy-to-use alternative to complex paper-based Average Length of Stay (days) 4.71 patients with diabetes. Prior to the protocols and can be adopted in busy, high-volume availability of computer-guided insulin facilities that treat high-risk patients. In the future, Total Number of POC Glucose Tests 4,174 dosing algorithms, bedside nurses had it will be desirable to study the impact of eGMS® Median Time to Target (hrs) 6.0 to use complex paper-based protocols, on incidence of neonatal hypoglycemia requiring which poses high risk of error. admission to the NICU for IV dextrose therapy. Median Time on eGMS® (hrs) 7.0

Glytec®, eGlycemic Management System®, e G M S ® and Glucommander™ are trademarks of Glytec, LLC on behalf of Aseko, Inc.