The Clinical Challenge

Hyperglycemia is a common problem in acutely ill patients, and can lead to serious complications associated with increased morbidity and mortality.^1,2 This clinical problem can occur in both diabetic and non-diabetic patients alike. Complications can include:

• Increased risk of nosocomial infection^1,2,4
• Impaired immune system⁵
• Delayed wound healing ³
• Volume depletion¹³
• Increased risk of death and impairment post-stroke in non-diabetic patients¹⁰

Studies have shown that maintaining normoglycemia can lead to improved outcomes in acutely ill patients.^1,2,3 However, the intensive insulin therapy needed to achieve normoglycemia can raise the risk of hypoglycemia, and increases the already high burden of work on the clinical staff.⁹ Insulin is also a challenging medication for the staff to work with. According to the Institute for Healthcare Improvement (IHI), insulin is a "high alert" medication that is frequently associated with medication errors in the hospital. This organization considers insulin to be one of the highest risk medications currently used in the hospital.⁷

The Financial and Patient Impact

It is established in the medical literature that hyper- and hypoglycemia can lead to increases in patient morbidity and mortality¹. This can lead to significantly increased costs for a hospital. For example, it is estimated that treating one nosocomial infection can cost approximately $40,000.¹¹

Additionally, as of October 1, 2008, Medicare has selected eight Hospital Acquired Conditions (HAC's) for which it will no longer pay at a higher weighted MS-DRG. One of these is Glycemic Control.

"...we believe that extreme manifestations of poor glycemic control are reasonably preventable through the application of evidence-based guidelines and sound medical practice while in the hospital setting..." ⁶

For patients, particularly non-diabetics, the impact of untreated hyperglycemia in the acute setting can be devastating. Total in-patient mortality for those with new hyperglycemia is over eight times higher than normoglycemic patients. For those patients in an ICU setting, three out of 10 new hyperglycemic patients will not survive, compared with only one in 10 normoglycemic patients.¹¹ These patients need quick diagnosis, and, most importantly, effective treatment.

EndoTool^®

EndoTool is a unique software system for managing glycemic control in your hospital. This FDA-cleared system will effectively control blood glucose levels, even in the most challenging patients.¹² EndoTool is installed on your hospital's existing IT system. For the staff, it is easy to use, needing only a current blood glucose level from a point-of-care device to compute the patient's correct insulin dose. EndoTool will even prompt you when the patient is glycemically stable, and is ready to be transferred over to subcutaneous insulin via patient-specific orders generated by EndoTool.

Please click here for an in-depth discussion of what EndoTool can do for you, your patients, and your hospital.

References

1. Van den Berghe G, et al. N Engl J Med 2001; 345:1359-67.
2. Van den Berghe G, et al. N Engl J Med 2006; 354:449-61.
3. Inzucchi SE, et al. N Engl J Med 2006; 355:1903-11
4. Furnary AP, et al. Ann Thorac Surg 1999; 67:352-60.
5. Nielson C, et al. Diabetes 1989;38:1031-35.
6. CMS-1390-F
7. Institute for Healthcare Improvement (IHI). ISMP’s List of High-Alert Medications 2008. Available at: www.ismp.org/Tools/highalertmedications.pdf. Accessed on October 3, 2008.
8. Zhan C, et al. JAMA 2003;290:1868-74
9. Aragon D. Am J Crit Care 2006; 15:370-77.
10. Yong M, et al. Stroke 2008;39:2749-2755.
11. Umpierrez GE, et al. J Clin Endo Metab 2002;87:978-982
12. Data on file, Hospira, Inc.
13. Narins GN. Maxwell & Kleemans's Clinical Disorders. 1994;5th Ed.,p.832.