Document Detail


Risk of Hypoglycemia in Post-operative Cardiovascular Surgery Patients Treated with Computer-based Versus Paper-based Insulin Therapy.
MedLine Citation:
PMID:  22440994     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective: To evaluate the safety and efficacy of replacing a paper protocol (PAPER) with a computer-guided glucose management system (GMS) for the treatment of post-operative hyperglycemia in cardiovascular intensive care (CVICU).Methods: Using a before and after analysis adult patients (≥ 18 years) discharged from the CVICU and treated with PAPER were compared with patients discharged from the CVICU and managed with GMS. Sixteen hundred forty eight patients were analyzed of whom 991 were managed with GMS. Clinical endpoints were evaluated using the Wilcoxon test. Unadjusted and adjusted hazard ratios (HR) for each hypoglycemic endpoint were calculated from Cox (proportional hazards regression) models using the PHREG procedure and clinical endpoints were adjusted for potential confounders.Results: Patients treated with PAPER were six times as likely to experience clinical hypoglycemia [blood glucose (BG) ≤70 mg/dL] as patients treated with GMS [adjusted hazard ratio (HR) = 6.06, P <0.0001], and more than seven times as likely to experience severe hypoglycemia (BG ≤40mg/dL) [adjusted HR=7.59, P =0.01]. Despite the increased risk of hypoglycemia, no difference in length of stay or mortality was observed between the groups.Conclusion: GMS treatment of post-operative hyperglycemic CVICU patients can successfully attain goal glucose with a significant reduction in hypoglycemia compared to a paper protocol. This association persists after controlling for covariates.
Authors:
Samuel E Crockett; Jorge Suarez-Cavelier; Kevin D Accola; Lori A Hadas; Darcey L Harnage; Paul R Garrett; Kathy A Butler; Zuber D Mulla
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-22
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  -     ISSN:  1934-2403     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-27     Citation Subset:  -    
Affiliation:
Adventist Health System, Orlando, Florida.
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