Risk of Postoperative Hypoglycemia in Cardiovascular Surgical Patients Receiving Computer-Based Versus Paper-Based Insulin Therapy

Case Study

Objective

To evaluate the safety and efficacy of replacing a paper-based protocol with a computer-guided glucose management system (CGMS) for the treatment of postoperative hyperglycemia in the cardiovascular intensive care unit (CVICU).

Conclusions

CGMS treatment of postoperative hyperglycemia in CVICU patients can successfully attain goal glucose levels with a significant reduction in hypoglycemia in comparison with a paper protocol. This association persists after controlling for covariates.

Gain Control Without Hypoglycemia

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Mild Hypoglycemia < 70 mb/dL

Patients treated with the paper protocol were 6 times as likely to experience clinical hypoglycemia as patients treated with the computer-guided glucose management system.

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Severe Hypoglycemia < 40 mb/dL

Patients treated with the paper protocol were 7 times as likely to experience clinical hypoglycemia as patients treated with the computer-guided glucose management system.

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Improved Safety

CGMS is a treatment modality that facilitates attainment of appropriate glucose goals by using advanced mathematics amenable to bedside use and with the potential of a low incidence of hypoglycemia and improved patient safety.

Publication Information

Author(s): Samuel E. Crockett, MD; Jorge Suarez-Cavelier, MD; Kevin D. Accola, MD; Lori A. Hadas, MSN; Darcey L. Harnage, BSN; Paul R. Garrett, MD; Kathy A. Butler, MPH; Zuber D. Mulla, PhD

Location: Adventist Health System, Orlando, FL

Source: Endocrine Practice, Vol 18 No. 4 July/August 2012, page 529-537