The study is a post-hoc cost analysis of the GLUCO-CABG trial, a randomized open-label clinical study (NCT: 01792830) of CABG surgery patients with and without diabetes who experienced perioperative hyperglycemia (defined as a blood glucose greater than 140 mg/dL). A total of 302 patients between ages 18 and 80 were randomized to an intensive glycemic control group (target blood glucose of 100 to 140 mg/dL) or a conservative glycemic control group (target blood glucose of 141 to 180 mg/dL). Both groups were treated using Glucommander to guide intravenous insulin dosing while in the ICU.
“We observed a significant reduction in cost between those treated to the intensive target and those treated to the conservative target,” explained a study author, Dr. Guillermo Umpierrez, professor of medicine and director of clinical research for the Diabetes and Metabolism Center at Emory University. “This reduction, which was more than $3,600 per patient, is the result of multiple factors. Not only did we reduce complications and length of stay, we reduced resource utilization across pharmacy, radiology, laboratory, consultations and ICU.”
Watch Dr. Umpierrez discuss the GLUCO-CABG study in more detail in the video below:
Study data indicate the mean blood glucose was 132.5 mg/dL among patients in the intensive glycemic control group and 154.4 mg/dL among patients in the conservative glycemic control group, which Umpierrez believes is the primary factor behind the reduction in perioperative complications (of near 20 percent). Umpierrez also believes the reduction in complications contributed to the reduction in both ICU stay (of 1.2 days) and hospitalization costs.
“A measure advance in the treatment of inpatient hyperglycemia, especially in the intensive care area, has been the development of computer-guided algorithms for insulin dosing; also, alerts to help the nurses stay on top of glycemic indicators and blood glucose checks,” Umpierrez said. “We use the Glytec system with Glucommander to help facilitate hyperglycemic management, and adjust insulin dosing according to the many changes that happen in the ICU, in a safe way.”
Glucommander is a U.S. Food and Drug Administration (FDA)-cleared decision support solution for intravenous and subcutaneous insulin dosing in the treatment of patients both with and without diabetes. Healthcare providers are able to access Glucommander through Glytec’s eGlycemic Management System, or eGMS, a software-as-a-service platform that also includes GlucoSurveillance for enterprise-wide surveillance of hyperglycemia, GlucoView for glycemic status indicators and glucose check alerts, and GlucoMetrics for analytics and reporting. For maximum efficiency and ease of use, eGMS is most typically integrated with an electronic medical record (EMR) system.
The most important consideration in the improvement of glycemic control, Umpierrez said, is safety: “Hypoglycemia has been shown to be associated with higher morbidity, mortality and hospitalization costs. Thus, physicians frequently avoid intensive glycemic control due to fear of hypoglycemia. To break treatment inertia, we need safe tools to improve glycemic control with minimal risk of hypoglycemia. I think the GLUCO-CABG trial and other studies recently published have clearly indicated that improving glycemic control with minimal risk of hypoglycemia results in improved outcomes.”
Another key observation from the post-hoc cost analysis of the GLUCO-CABG trial was the difference in economic outcomes when comparing patients with perioperative complications to patients without perioperative complications. “We found that patients with perioperative complications had a longer overall length of stay, by four days (10.7 days vs. 6.7 days; p=0.001), higher total hospitalization costs ($48,299 vs. $32,675; p=0.001) and more resource utilization units (2,745 vs. 1,710; p=0.001),” explained lead author Dr. Saumeth Cardona, clinical research coordinator IV in the Division of Endocrinology, Metabolism and Lipids at Emory University.
The newly-published study is one of several initiatives Umpierrez and his research team have undertaken and continue to pursue that leverage Glytec’s eGMS. Raymie McFarland, vice president of quality initiatives at Glytec, says: “We were privileged and honored to work with Dr. Umpierrez, Dr. Cardona and their colleagues on the GLUCO-CABG trial, and we look forward to the results of multiple other studies currently in progress. At Glytec, we are driven by the evidence. We use it as the basis for continuous improvement of our products and services, to help our clients achieve best practice in glycemic management in the intensive care areas, on the patient floors, in long term acute care facilities and outside the hospital environment as well.”
Founded in 2006, Glytec develops diabetes therapy management software, enabling healthcare organizations to achieve best practice for glucose control and standardize care for inpatients and outpatients alike. The company’s eGlycemic Management System (eGMS) has been proven to dramatically reduce drivers of cost and clinical variation, including incidence of hypoglycemia, readmissions, length of stay, complications and A1C levels. Its efficacy and safety have been validated by more than 55 research studies. eGMS centers on an FDA-cleared insulin dosing solution that supports personalized intravenous and subcutaneous therapy for adult and pediatric populations. It integrates seamlessly with EMR systems and connected device platforms for streamlined use across the entire continuum of care, including at-home, provider-directed care managed through telehealth, population health and other value-based programs. The company’s cloud-hosted software-as-a-service (SaaS) delivery model allows for rapid implementation and anytime, anywhere access. Glytec has offices in Waltham, Mass., and Greenville, S.C.