title: Comparison of an Electronic Glycemic Management System Versus Provider-Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting.
abstract: American Diabetes Association (ADA) guidelines recommend a basal bolus correction insulin regimen as the preferred method of treatment for non-critically ill hospitalized patients. However, achieving ADA glucose targets safely, without hypoglycemia, is challenging. In this study we evaluated the safety and efficacy of basal bolus subcutaneous (SubQ) insulin therapy managed by providers compared to a nurse-directed Electronic Glycemic Management System (eGMS).
  
  
  
  This retrospective crossover study evaluated 993 non-ICU patients treated with subcutaneous basal bolus insulin therapy managed by a provider compared to an eGMS. Analysis compared therapy outcomes before Glucommander (BGM), during Glucommander (DGM), and after Glucommander (AGM) for all patients. The blood glucose (BG) target was set at 140-180 mg/dL for all groups. The safety of each was evaluated by the following: (1) BG averages, (2) hypoglycemic events <40 and <70 mg/dL, and (3) percentage of BG in target.
  
  
  
  Percentage of BG in target was BGM 47%, DGM 62%, and AGM 36%. Patients' BGM BG average was 195 mg/dL, DGM BG average was 169 mg/dL, and AGM BG average was 174 mg/dL. Percentage of hypoglycemic events <70 mg/dL was 2.6% BGM, 1.9% DGM, and 2.8% AGM treatment.
  
  
  
  Patients using eGMS in the DGM group achieved improved glycemic control with lower incidence of hypoglycemia (<40 mg/dL and <70 mg/dl) compared to both BGM and AGM management with standard treatment. These results suggest that an eGMS can safely maintain glucose control with less hypoglycemia than basal bolus treatment managed by a provider.
authors.affiliation: 1 Wake Forest School of Medicine, Winston Salem, NC, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Aloi
authors.affiliation: 2 Atlanta Diabetes Associates, Atlanta, GA, USA.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Bode
authors.affiliation: 3 Eastern Virginia Medical School, Norfolk, VA, USA.
authors.forename: Jagdeesh
authors.initials: J
authors.lastname: Ullal
authors.affiliation: 4 Sentara Health, Norfolk, VA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Chidester
authors.affiliation: 5 Glytec, Waltham, MA, USA.
authors.forename: Raymie S
authors.initials: RS
authors.lastname: McFarland
authors.affiliation: 5 Glytec, Waltham, MA, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Bedingfield
authors.affiliation: 5 Glytec, Waltham, MA, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Mabrey
authors.affiliation: 5 Glytec, Waltham, MA, USA.
authors.forename: Robby
authors.initials: R
authors.lastname: Booth
authors.affiliation: 6 Mountain States Health Alliance, Johnson City, TN, USA.
authors.forename: April
authors.initials: A
authors.lastname: Mumpower
authors.affiliation: 7 Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Amisha
authors.initials: A
authors.lastname: Wallia
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015994:Incidence; D007279:Injections, Subcutaneous; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Glucommander; and subcutaneous insulin; computerized insulin algorithm; diabetes; glycemic management; hypoglycemia