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ADA Virtual 81st Scientific Sessions


June 25, 2021


Bruce Bode, MD, FACE¹, John Clarke, RN, CDCES², Jordan Messler, MD, SFHM, FACP², Robert Booth, CPHQ²


¹Atlanta Diabetes Associates, Atlanta, GA, USA, ²Glytec, Waltham, MA, USA,



Hyperglycemia (BG >140 mg/dl) and hypoglycemia (BG <70 mg/dl) occur frequently in the hospital and are linked to poor outcomes and increased cost. Chronic kidney disease and acute kidney injury patients require special attention when receiving insulin in the hospital. Hypoglycemia rates are higher in this group and the causes continue to be investigated. The American Diabetes Association (ADA) has recommended a glucose target of 140 to 180 mg/dl and a conservative starting insulin requirement for renal impaired and the elderly.



We examined individual-level data from 2017 to 2021 from the Glytec® Inpatient Database, a group of 13,775 patients in the ICU across 206 hospitals, with eGFR <60 ml/min/1.73 m2 and with at least two glucose values >180 mg/dl. All patients were treated using Glucommander (GM) IV, the dosing module within Glytec’s eGMS®, to titrate IV insulin and followed order set initiation recommendations for renal failure. Confirmatory POC glucose measurements within 5 minutes of the initial hypoglycemia reading were used as the primary value if the reading was no longer below the hypoglycemia range.



The results were compared to published data from other electronic glycemic management tools. The line for eGFR <15 in the Insulin Rate /kg chart does not conform to the trend shown by the other three lines but requires less insulin, possibly related to reduced insulin clearance.



When using Glucommander’s proprietary nonlinear IV insulin infusion software and an appropriate order set, renal impaired patients had low hypoglycemia rates and acceptable glycemic control. There were few large comparator studies, all with higher hypoglycemic rates and none of which reported outcomes in patients with renal impairment.


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