Raymie McFarland

For all the benefits that come with technology in healthcare, there is no replacement for the human touch. The rapid adoption of digital healthcare thanks to the COVID-19 pandemic forced many healthcare organisations to embrace technology to treat patients from afar. So where does digital healthcare go now that restrictions are easing, and doctors’ offices are reopening?

Improving the care relationship

Digital healthcare platforms should now be used to improve the… Show more

For all the benefits that come with technology in healthcare, there is no replacement for the human touch. The rapid adoption of digital healthcare thanks to the COVID-19 pandemic forced many healthcare organisations to embrace technology to treat patients from afar. So where does digital healthcare go now that restrictions are easing, and doctors’ offices are reopening?

Improving the care relationship

Digital healthcare platforms should now be used to improve the clinician/patient relationship through technology even though the number of in-person visits is increasing. The use of digital healthcare is not about technology replacing humans. Instead, it is about augmenting and supplementing providers to improve the ways they deliver care. It can relieve clinicians of routine and administrative tasks affording them more opportunities to practice at the top of their license.

The use of a digital healthcare platform can streamline the workflow on the administrative side and provide the clinicians with more time to focus on the patients. Clinicians I have spoken to say one issue they experience is they are pulled in too many different directions when it comes to patient assessments, keeping records, and other paperwork. We can now give the caregivers one place, one platform, where they can perform all these duties. Saving precious time that can be dedicated to focusing on their patients. Show less

OBJECTIVE

Diabetes and hyperglycemia are important risk factors for poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). We hypothesized that achieving glycemic control soon after admission, in both intensive care unit (ICU) and non-ICU settings, could affect outcomes in patients with COVID-19.

RESEARCH DESIGN AND METHODS

We analyzed pooled data from the Glytec national database including 1,544 patients with COVID-19 from 91 hospitals in 12… Show more

OBJECTIVE

Diabetes and hyperglycemia are important risk factors for poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). We hypothesized that achieving glycemic control soon after admission, in both intensive care unit (ICU) and non-ICU settings, could affect outcomes in patients with COVID-19.

RESEARCH DESIGN AND METHODS

We analyzed pooled data from the Glytec national database including 1,544 patients with COVID-19 from 91 hospitals in 12 states. Patients were stratified according to achieved mean glucose category in mg/dL (≤7.77, 7.83–10, 10.1–13.88, and >13.88 mmol/L; ≤140, 141–180, 181–250, and >250 mg/dL) during days 2–3 in non-ICU patients or on day 2 in ICU patients. We conducted a survival analysis to determine the association between glucose category and hospital mortality.

RESULTS

Overall, 18.1% (279/1,544) of patients died in the hospital. In non-ICU patients, severe hyperglycemia (blood glucose [BG] >13.88 mmol/L [250 mg/dL]) on days 2–3 was independently associated with high mortality (adjusted hazard ratio [HR] 7.17; 95% CI 2.62–19.62) compared with patients with BG <7.77 mmol/L (140 mg/dL). This relationship was not significant for admission glucose (HR 1.465; 95% CI 0.683–3.143). In patients admitted directly to the ICU, severe hyperglycemia on admission was associated with increased mortality (adjusted HR 3.14; 95% CI 1.44–6.88). This relationship was not significant on day 2 (HR 1.40; 95% CI 0.53–3.69). Hypoglycemia (BG <70 mg/dL) was also associated with increased mortality (odds ratio 2.2; 95% CI 1.35–3.60).

CONCLUSIONS

Both hyperglycemia and hypoglycemia were associated with poor outcomes in patients with COVID-19. Admission glucose was a strong predictor of death among patients directly admitted to the ICU. Severe hyperglycemia after admission was a strong predictor of death among non-ICU patients. Show less

Introduction:
Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia.

Methods:
This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020… Show more

Introduction:
Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia.

Methods:
This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020. Diabetes was defined as A1C ≥6.5%. Uncontrolled hyperglycemia was defined as ≥2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted from Glytec’s data warehouse.

Results:
Among 1122 patients in 88 U.S. hospitals, 451 patients with diabetes and/or uncontrolled hyperglycemia spent 37.8% of patient days having a mean BG > 180 mg/dL. Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycemia (P < .001). Among the 184 patients with diabetes and/or hyperglycemia who died or were discharged, 40 of 96 uncontrolled hyperglycemia patients (41.7%) died compared with 13 of 88 patients with diabetes (14.8%, P < .001). Among 493 discharged survivors, median length of stay (LOS) was longer in 184 patients with diabetes and/or uncontrolled hyperglycemia compared with 386 patients without diabetes or hyperglycemia (5.7 vs 4.3 days, P < .001).

Conclusion:
Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer LOS and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate. We recommend health systems which ensure that inpatient hyperglycemia is safely and effectively treated. Show less

Glytec’s Glucommander electronic glucose management system (eGMS) helped the Kaweah Delta hospital shift its standard of care to basal-bolus insulin, explained Raymie McFarland, vice president of Quality Initiatives at Glytec. Basal-bolus is considered best practice and is safer for patients, but many hospitals have not adopted it due to its difficulty, but Glytec hopes its eGMS can change that. It presented a study at the American Diabetes Association (ADA) Scientific Sessions June 9-13, 2017.

METHODS
This retrospective study evaluated 3198 patients with AMI, CHF or undergoing a CABG procedure who were admitted to a 13 hospital health system over a 12 month time frame from January 2015 through December 2015. Qualifying patients were treated with eGMS IV and/or SubQ insulin management or those treated by SC. The main outcome measure was Risk Adjusted Readmission Rates.
RESULTS
Patients (n=281) treated with eGMS had a Risk Adjusted Readmission rate of 0.75 for AMI, 0.34 for… Show more

METHODS
This retrospective study evaluated 3198 patients with AMI, CHF or undergoing a CABG procedure who were admitted to a 13 hospital health system over a 12 month time frame from January 2015 through December 2015. Qualifying patients were treated with eGMS IV and/or SubQ insulin management or those treated by SC. The main outcome measure was Risk Adjusted Readmission Rates.
RESULTS
Patients (n=281) treated with eGMS had a Risk Adjusted Readmission rate of 0.75 for AMI, 0.34 for CHF and 0.65 for CABG. Patients (n=2917) treated with SC had a Risk Adjusted Readmission rate of 1.17 for AMI, 0.97 for CHF and 2.04 for CABG. The p values from the t-tests of the observed cardiac patient groups (p=0.019 SD 2.990, 2.618) determined statistical 95% significance p<0.05, particularly for CHF (p<0.009 SD 1.993, 0.905). Patients treated with eGMS had a reduced Risk Adjusted Readmission rate of 36% for AMI, 65% reduction for CHF and 68% for CABG.
CONCLUSION
The evidence presented in these results suggest that glycemic control using eGMS can effectively reduce the rate of readmission for patients with cardiovascular disease who are in need of insulin management. There is enough evidence supporting a decrease in Risk-Adjusted readmission rates among groups treated with eGMS management.
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Background:
American Diabetes Association (ADA) guidelines recommend a basal bolus correction insulin regimen as the
preferred method of treatment for non–critically ill hospitalized patients. However, achieving ADA glucose targets safely,
without hypoglycemia, is challenging. In this study we evaluated the safety and efficacy of basal bolus subcutaneous (SubQ)
insulin therapy managed by providers compared to a nurse-directed Electronic Glycemic Management System (eGMS).
Method:… Show more

Background:
American Diabetes Association (ADA) guidelines recommend a basal bolus correction insulin regimen as the
preferred method of treatment for non–critically ill hospitalized patients. However, achieving ADA glucose targets safely,
without hypoglycemia, is challenging. In this study we evaluated the safety and efficacy of basal bolus subcutaneous (SubQ)
insulin therapy managed by providers compared to a nurse-directed Electronic Glycemic Management System (eGMS).
Method:
This retrospective crossover study evaluated 993 non-ICU patients treated with subcutaneous basal bolus insulin
therapy managed by a provider compared to an eGMS. Analysis compared therapy outcomes before Glucommander (BGM),
during Glucommander (DGM), and after Glucommander (AGM) for all patients. The blood glucose (BG) target was set at
140-180 mg/dL for all groups. The safety of each was evaluated by the following: (1) BG averages, (2) hypoglycemic events
<40 and <70 mg/dL, and (3) percentage of BG in target.
Result:
Percentage of BG in target was BGM 47%, DGM 62%, and AGM 36%. Patients’ BGM BG average was 195 mg/dL,
DGM BG average was 169 mg/dL, and AGM BG average was 174 mg/dL. Percentage of hypoglycemic events <70 mg/dL was
2.6% BGM, 1.9% DGM, and 2.8% AGM treatment.
Conclusion:
Patients using eGMS in the DGM group achieved improved glycemic control with lower incidence of hypoglycemia
(<40 mg/dL and <70 mg/dl) compared to both BGM and AGM management with standard treatment. These results suggest that
an eGMS can safely maintain glucose control with less hypoglycemia than basal bolus treatment managed by a provider Show less

Thirty-five patients seen in the ED with hyperglycemic crises and diagnosed with DKA during one calendar year were reviewed. A retrospective chart review was performed on patients who were placed on Glucommander for DKA management. Use of Glucommander for guiding the insulin treatment of mild DKA in the ED can decrease admissions to the hospital for DKA by 45%. Low rates of hypoglycemia make this an option to improve efficiency of utilization of inpatient hospital beds. The cost savings for… Show more

Thirty-five patients seen in the ED with hyperglycemic crises and diagnosed with DKA during one calendar year were reviewed. A retrospective chart review was performed on patients who were placed on Glucommander for DKA management. Use of Glucommander for guiding the insulin treatment of mild DKA in the ED can decrease admissions to the hospital for DKA by 45%. Low rates of hypoglycemia make this an option to improve efficiency of utilization of inpatient hospital beds. The cost savings for non-admissions were estimated at $78,000 over the 12 months of the study. Our results suggest that Glucommander is a safe and efficient tool for use in the ED to manage mild to moderate DKA. Show less

This study explores the relationship between education for inpatient diabetes providers and the utilization of insulin order sets, inpatient glucometrics, and length of stay in a large health care system. The study included patients with and without the diagnosis of diabetes.