Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment for patients with hematological malignancies. However, is associated with substantial rates of morbidity and mortality. We and others have shown that malglycemia is associated with adverse transplant outcome. Therefore, improving glycemic control may improve transplant outcome. In this prospective study we evaluated the feasibility of using Glucommander (a Computer-Guided Glucose Management System; CGGM) in order to achieve improved glucose control in hospitalized HCT patients. Nineteen adult patients contributed 21 separate instances on CGGM. Patients were on CGGM for a median of 43 h. Median initial blood glucose (BG) on CGGM was 244 mg/dL, and patients on 20 study instances reached the study BG target of 100-140 mg/dL after a median of 6 h. After BG reached the target range, the median average BG level per patient was 124 mg/dL. Six patients had a total of 10 events of BG o 70 mg/dL (0.9% of BG measurements), and no patients experienced BG level o 40 mg/dL. The total estimated duration of BG o 70 mg/dL was 3 h (0.2% of the total CGGM time). In conclusion, our study demonstrates that stringent BG control in HCT patients using CGGM is feasible.

Risk of Hypoglycemia During Insulin Infusion Directed by Paper Protocol Versus Electronic Glycemic Management System in Critically Ill Patients at a Large Academic Medical Center

“…In addition to unique cross-over design this study was done in a complex patient population with high morbidity, mortality, total parenteral nutrition utilization and inflammatory responses which are also experienced in critically ill patients. 22 Our study demonstrates that glycemic variability may also be reduced by utilization of an eGMS compared to a PBP. Coupled with hypoglycemia, increasing glycemic variability has been described as a strong independent predictor of mortality regardless of patients' mean glucose concentration.…”

“…In addition to unique cross-over design this study was done in a complex patient population with high morbidity, mortality, total parenteral nutrition utilization and inflammatory responses which are also experienced in critically ill patients. 22…”

Trajectories of Fasting Blood Glucose in Autologous Hematopoietic Cell Transplantation

“…However, this level of control required intensive hourly glucose monitoring. 34 The implementation of this intense level of monitoring and management may not be clinically feasible. In addition, patients without pre-existing diabetes who experience hyperglycemic episodes during HCT may not require continuous insulin therapy.…”

Analysis of “Comparison an Electronic Glycemic Management System Versus Provider Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting”

“…2 For this reason, computerized decision support systems have gained importance in recent years and their clinical performance has been investigated in several studies in different settings such as intensive care medicine, emergency department and general ward. [3][4][5][6][7] Aloi et al evaluated the safety and efficacy of basal bolus subcutaneous insulin therapy managed by providers, compared to a nurse-directed electronic glycemic management system (eGMS) using Glucommander in a retrospective observational crossover study in 993 non critically-ill patients across 9 different hospitals. 4 Mean blood glucose, number of hypoglycemic events less than 40 mg/dl and 70 mg/dl and the percentage of blood glucose in target (140-180 mg/dl) before (BGM), during (DGM), and after (AGM) the use of eGMS were compared.…”

“…2 For this reason, computerized decision support systems have gained importance in recent years and their clinical performance has been investigated in several studies in different settings such as intensive care medicine, emergency department and general ward. 3-7…”