Novant Health System, Charlotte, NC, USA.
Wingate University School of Pharmacy, Wingate, NC, USA.
J Diabetes Sci Technol. 2021 Mar;15(2):242-250. doi: 10.1177/1932296821992352. Epub 2021 Feb 15.
Glucommander™ (GM), an electronic glycemic management system, was implemented across a multi-hospital health system as the standard of care for glycemic control. GM provides insulin dosing recommendations based on patient-specific blood glucose (BG) trends after providers select either a custom dose or weight-based multiplier as the initial dosing strategy for the first 24 hours. This study evaluated the impact of initial subcutaneous (SC) GM insulin dosing strategies on glycemic management.
Non-intensive care unit patients treated with SC GM using either initial custom (based on provider discretion) or weight-based multiplier settings (0.3, 0.5, or 0.7 units/kg/day) were evaluated in this retrospective chart review. The primary endpoint was time to target BG range defined as time to first two consecutive in range point of care BG. Secondary endpoints included percentage of BG values in target range, percentage of orders following institutional recommendations, length of stay (LOS), average BG, and incidence of hypoglycemia and hyperglycemia.
A review of 348 patients showed time to target BG was not significantly different between custom and multiplier groups (55 vs 64 hours, = .07). Target BG was achieved in less than half of patients in both groups (47% vs 44%, respectively). There were no differences in hospital LOS, proportion of BG in target range, rates of hypo/hyperglycemia, and average BG.
Custom initial SC GM insulin dosing settings showed a nonsignificant decrease in time to target BG range compared to pre-defined multiplier settings. Future studies evaluating the impact of compliance with institutional recommendations on BG control are warranted.
Glucommander™（GM）是一种电子血糖管理系统，在一个多医院医疗系统中被作为血糖控制的标准护理措施实施。GM 根据患者特定的血糖（BG）趋势提供胰岛素剂量建议，在提供者选择初始剂量策略时（定制剂量或体重倍数），在前 24 小时内使用。本研究评估了初始皮下（SC）GM 胰岛素给药策略对血糖管理的影响。
本回顾性图表研究评估了使用初始定制（根据提供者的判断）或体重倍数设置（0.3、0.5 或 0.7 单位/千克/天）的 SC GM 治疗的非重症监护病房患者。主要终点是达到目标 BG 范围的时间，定义为首次连续两次在范围内的即时 BG 点的时间。次要终点包括目标范围内的 BG 值百分比、遵循机构建议的医嘱百分比、住院时间（LOS）、平均 BG 以及低血糖和高血糖的发生率。
对 348 例患者的回顾显示，定制组和倍数组达到目标 BG 的时间无显著差异（55 小时对 64 小时， =.07）。两组均不到一半的患者达到目标 BG（分别为 47%和 44%）。两组患者的 LOS、目标范围内的 BG 比例、低血糖/高血糖发生率以及平均 BG 均无差异。
与预定义的倍数设置相比，初始 SC GM 胰岛素的定制剂量设定在达到目标 BG 范围方面表现出非显著减少。需要进一步研究评估遵循机构建议对 BG 控制的影响。
