Raymie McFarland Discusses Findings From Glytec's Basal-Bolus Insulin Study

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.

Transcript (slightly modified)

Can you discuss the Kaweah Delta findings being presented at the ADA Scientific Sessions?

The poster that’s being presented is a case study looking at a 500-plus bed hospital in the San Joaquin Valley of California. It’s a facility named Kaweah Delta Regional Medical Center. Kaweah Delta is a very interesting case in that they did not have expertise from an endocrinology standpoint either in or outside the hospital or the health system facilities.

Kaweah Delta was a practice in the past that used a lot of sliding-scale, and the evidence that’s being presented is really looking at everything from improved education; a change in their order sets; full adoption of our eGMS, our e-glycemic management system, with Glucommander running both IV, transition, and sub-Q [subcutaneuous] orders and management of all their insulin.

Why is it important to follow best practices around basal-bolus insulin?

Over 10 years ago, AACE (American Association of Clinical Endocrinologists) and ADA both recommended to move away, for practitioners and hospitals, to move away from sliding-scale to basal-bolus. In fact, there were several articles written by the name of RABBIT and RABBIT Surgery by Dr Guillermo Umpierrez that really focused on the move from sliding-scale to basal-bolus, that really proved that it was more efficacious and better for patients, reduced hypoglycemia and such, so better safety.

At Kaweah Delta, they used sliding-scale over 95% of the time, so a majority of their practice was using what we would consider an old practice, but really it’s what’s used in most hospitals today.

Why aren’t best practices regarding sliding-scale vs. basal-bolus insulin being followed?

Sliding-scale insulin in the hospital setting is easy. It’s very easy to write the order and walk away. Basal-bolus insulin management with correction is very difficult, it’s cumbersome, it’s something that a provider has to go in every day and make a change to. So the adoption of basal-bolus, even though it is best practice and it’s what’s best for patients, isn’t something that we see widely used across the hospitals.