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 Obstetrics and Gynecology This retrospective quality improvement study examined rates of moderate hypoglycemia <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 hyperglycemia >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 therapy. 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.