Implementation of the Glucommander Method of Adjusting Insulin Infusions in Critically Ill Patients

Yamashita, Sharon; Ng, Emily; Brommecker, Frank; Silverberg, Jay; Adhikari, Neill K. J.

doi:10.4212/cjhp.v64i5.1068

Cited by 15 publications

(13 citation statements)

References 14 publications

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“…These results placed VMC in the top 10% of all U.S. hospitals for HAC-8 compliance (38). Research has documented the improved performance of eGMS systems compared with paper algorithms (23)(24)(25)(27)(28)(29)31,39). However, it has been difficult to determine what factors are responsible for this superiority.…”

mentioning

confidence: 99%

Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year, Retrospective Observational Study at A Tertiary Care Teaching Hospital

et al. 2017

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mentioning

confidence: 99%

Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year, Retrospective Observational Study at A Tertiary Care Teaching Hospital

et al. 2017

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“…Yet the goal of achieving this control remains elusive due to the limitations of our current open loop methods [4] that still require manual testing of glucose values, entry of the measured value into local or web based glucose control software, and manual adjustment of the intravenous pumps infusing insulin into the ICU patient. In order to improve overall glucose control, ICU care givers will need to be empowered with a closed loop glucose control system.…”

Section: Is Closed Loop Glucose Control For Icumentioning

confidence: 99%

Is Closed Loop Glucose Control for ICU Patients Just Around the Corner?

DeJournett¹,

DeJournett²

2017

J Intensive Crit Care

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Effective glucose control in the Intensive Care Unit (ICU) setting has the potential to lower mortality rates [1], shorten length of stay [2] and decrease overall cost of care [3]. Yet the goal of achieving this control remains elusive due to the limitations of our current open loop methods [4] that still require manual testing of glucose values, entry of the measured value into local or web based glucose control software, and manual adjustment of the intravenous pumps infusing insulin into the ICU patient. In order to improve overall glucose control, ICU care givers will need to be empowered with a closed loop glucose control system.The three main components of a closed loop glucose control system are a glucose sensor(s), control algorithm, and intravenous pump(s). Current intravenous pumps are accurate and reliable enough for a closed loop system, so the two components preventing completion of the system are the glucose sensor(s) and controller. An accurate and reliable glucose sensor array is a must, as trying to control a system without real time knowledge of mission critical sensor data will invariably lead to unacceptable outcomes, as has been seen in the aerospace industry [5]. In fact, the aerospace industry provides an excellent example of how to properly engineer a safe and effective control system, as they routinely build in redundancy of mission critical system components to improve reliability and will also use different methods of measurement to improve overall accuracy.Studies on type I diabetics have shown that a multi-sensor array improves overall accuracy of the system [6]. The following equation can be used as a guide to determine the number of sensors N, needed given a known sensor failure rate p and a desired uptime rate q, where p, q ∈ [0,1]:As can be seen from Table 1 if the closed loop system requirement is to have a complete sensor failure rate limited to less than 10 min over a typical 96 h ICU length of stay, which is a greater than 99.8% uptime rate, and the known sensor failure rate is 1%, then the system requirement is to have two independent glucose sensors in place.Current CE marked blood based glucose sensors designed for use in the ICU setting have already been shown to be both highly accurate and reliable, with an uptime rate that exceeds 99% [7]. In addition, the next generation interstitial continuous glucose monitoring (CGM) system that Dexcom is developing with assistance from Google will not be affected by acetaminophen, making it a potential excellent candidate as the second sensor in a glucose array [8]. The ability to avoid interference from acetaminophen is important as this medication is known to affect the accuracy of current interstitial CGM systems, yet is ubiquitously used in the hospital setting. As sensor reliability is far more important than accuracy when it comes to closed loop glucose control [9], the improved uptime rate of a two sensor array will more than offset the decreased accuracy that will occur by averaging simultaneous blood and interstitial glucos...

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“…Computerized insulin infusion protocols such as Glucommander (Glytec, Greenville, SC) have been demonstrated to improve glycemic control, decrease the risk of calculation errors, and can provide reminders for BG checks. [15][16][17][18][19][20][21][22][23] A recent study demonstrated a 98.2% adherence rate to the insulin dose prescribed when using the Space GlucoseControl system (B. Braun, Melsungen, Germany). 23 However, errors can still occur in sampling interval, data entry, and pump programming.…”

Section: Nurse-managed Insulin Infusion Protocolmentioning

confidence: 99%

Evaluation of a Nurse-Managed Insulin Infusion Protocol

Passarelli

Gibbs

Rowden

et al. 2016

Diabetes Technology & Therapeutics

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Implementation of the Glucommander Method of Adjusting Insulin Infusions in Critically Ill Patients

Abstract: Background: Intensive glycemic control has been associated with reduced morbidity and mortality in critically ill patients. Web-based, patientspecific insulin nomograms may facilitate improved glucose control.

Cited by 15 publications

References 14 publications

Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year, Retrospective Observational Study at A Tertiary Care Teaching Hospital

Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year, Retrospective Observational Study at A Tertiary Care Teaching Hospital

Is Closed Loop Glucose Control for ICU Patients Just Around the Corner?

Evaluation of a Nurse-Managed Insulin Infusion Protocol

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