Visual Abstract
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 13775 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 on an eGMS to titrate IV insulin and followed Glucommander IV order set initiation recommendations for renal failure. The results were compared to published data from other eGMS. See Table for complete results. Conclusions: When using Glucommander 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.
B. W. Bode: Advisory Panel; Self; Eli Lilly and Company, Consultant; Self; Bigfoot Biomedical, Inc., Companion Medical, Lexicon Pharmaceuticals, Inc., Medtronic, Novo Nordisk Inc., Zealand Pharma A/S, Research Support; Self; Abvance Therapeutics, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Dompe, Eli Lilly and Company, Eyenuk, Inc., Insulet Corporation, Jaeb Center for Health Research, Medtronic, Nova Biomedical, Novo Nordisk, Provention Bio, Inc., REMD Biotherapeutics, Sanofi, Senseonics, Viacyte, Inc., vTv Therapeutics, Xeris Pharmaceuticals, Inc., Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk, Sanofi, Stock/Shareholder; Self; AgaMatrix, Aseko, Inc., Glytec, LLC. J. Clarke: Employee; Self; Aseko, Inc., Stock/Shareholder; Self; Aseko, Inc. J. Messler: Employee; Self; Glytec, LLC. R. Booth: Employee; Self; Glytec, LLC.
