Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 15

15 - MEASURE OF SAFETY FOR Q2 VS Q1 HOUR GLUCOSE CHECKS FOR INTRAVENOUS INSULIN DOSING

Thursday, Apr 25
12:30 PM – 1:00 PM

Objective : Paper protocols and electronic glucose management systems (eGMS) dosing algorithms for IV insulin make recommendations to change from every one-hour (Q1) blood glucose (BG) checks to every two-hour (Q2) checks based on various measures of the subject’s BG stability and mean BG. That measure of stability is different for the various published paper protocols and eGMS. This retrospective study is designed to evaluate the safety of the Q2 BG checks of an eGMS by analyzing the BG check timing of hypoglycemia events in a large database of patients. The hypothesis is that the measures of hypoglycemia, defined as BG less than 70 mg/dl for the Q2 should be equal to those for Q1 BG checks.


Methods : The timing before all BG checks scheduled for Q1 hour and Q2 hours was calculated from a database of 3.55 million de-identified BG readings without any exclusions from 5 unaffiliated hospital systems using an eGMS for IV insulin dosing. The frequency of hypoglycemia as a function of the minutes late time periods was calculated. The relative risk compared to a timely BG check is defined as the frequency of hypoglycemia for the defined periods divided by the frequency of hypoglycemia for BG readings less than 5 minutes late.


Results : The overall incidence of hypoglycemia for Q2 BG checks was less than that observed for the Q1 BG checks.  For the Q2 data at one hour, the relative risk is 3 when 55 to 65 minutes late and lower than the relative risk of 4 observed for Q1 BG checks 55 to 65 minutes late.  The mean BG following the Q2 check and the variance of those BGs after Q2 were also lower compared to that observed for Q1.


Discussion : The measures of hypoglycemia and the measures of BG control were superior with Q2 checks versus  Q1 checks, confirming that the algorithm and moving to Q2 BG checks is appropriate. Given the size of the database and statistical significance, these observations appear to confirm that using this eGMS algorithm for Q2 recommendations is safe.  In addition to the benefits for the patient, the appropriate transition to Q2 checks also has a significant positive impact for nursing workflow.


Conclusion :

Measures of safety for Q2 BG checks are needed for the clinical evaluation of the algorithms that recommend Q2 BG checks. These observations that the relative risk, the overall incidence of hypoglycemia, mean BG, and BG variance are superior to those observed for Q1 should be used to confirm the efficacy and safety of other Q2 recommendation protocol.

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W Patrick Burgess

Founder & Inventor, EndoTool
Monarch Medical Technologies
Charlotte, North Carolina

Dr. Patrick Burgess founded EndoTool in 2003 with the goal of improving glucose management for hospitalized patients. Today, he remains an active contributor to the development and advancement of the EndoTool suite of solutions as he pursues his goal of controlling elevated glucose levels in all settings and eliminating the threat of hypoglycemia.

Prior to founding EndoTool, Dr, Burgess spent more than 20 years practicing medicine in the Charlotte area. He served as a partner and president of Metrolina Nephrology Associates, P.A, and was affiliated with the Carolinas Medical Center, part of the Atrium Health System. At Carolinas Medical Center, Dr. Burgess served as the Chief of Internal Medicine and Chief of the Nephrology Division. He was involved in many physician leadership roles, including serving as the President of the Medical and Dental Staff. Dr. Burgess also served in teaching roles as a Clinical Associate Professor in the Department of Internal Medicine at Wake Forest University School of Medicine and for the Department of Medicine at the University of North Carolina.

Dr. Burgess received his bachelor’s in engineering from Ohio State University followed by a PhD in chemical engineering with a focus in digital control mathematics at Princeton University. He then later received his medical degree from the University of Miami and completed his residency and nephrology fellowship at the University of Alabama, Birmingham. Dr. Burgess is a frequent author and presenter, and continues to remain an active participant in industry societies. He is a member of the American Diabetes Association, American Medical Association, and American Society of Nephrology.

Laura Santana

Clinical Product Manager
Monarch Medical Technologies
Charlotte, North Carolina

Laura Santana is the Clinical Product Manager at Monarch. In her role, she provides clinical subject matter expertise to guide the strategic planning and development of the EndoTool applications. Laura is also responsible for validating new product feature and functions to ensure safety and efficacy, while also  providing training on the new elements of the software and impact to workflow. Laura has worked with EndoTool since it’s inception in 2006. Previously, she was an assistant nurse manager with Carolinas Healthcare System, now Atrium Health, in their post-operative recovery unit for adult and pediatric cardiac surgery patients. Laura earned her bachelor of science in nursing from Queens University of Charlotte.

Chris Santry

Clinical Services Specialist
Monarch Medical Technologies
Charlotte, North Carolina

Chris Santry, MSN, MBA, RN, CCRN is a Clinical Services Specialist at Monarch. In his role, he is responsible for supporting clients in the implementation and ongoing management of the EndoTool Glucose Management System. Chris works with clients to understand their existing glycemic management processes and protocols and address any gaps that may exist to ensure a successful implementation. Once in use, he continues to serve as a resource providing ongoing analysis and training to optimize EndoTool. Prior to Monarch, Chris was a critical care nurse at Gwinnett Medical Center and an adjunct instructor in the nursing department at Gwinnett Technical College.

Cathy L. Jaynes

Clinical Services Specialist
Monarch Medical Technologies
Denver, Colorado

Dr. Cathy Jaynes is a Clinical Services Specialist at Monarch Medical Technologies. In her role, she is responsible for supporting clients with the implementation and ongoing management of the EndoTool Glucose Management System. Cathy works with new clients to understand their existing insulin dosing workflow and protocols and address any process gaps that may exist to ensure a successful implementation. Once in use, she continues to serve as a resource for clients providing ongoing analysis and training to optimize EndoTool and improve safety of insulin therapy. Prior to Monarch, Cathy was Director of the Center for Medical Transport Research.

Laurel Fuqua

Executive VP and Chief Clinical Officer
Monarch Medical Technologies
Charlotte, North Carolina