LBODP063 The Benefits Of Using Cgm For Intravenous Insulin Therapy

 

Modern glycemic monitoring systems make it easier for doctors and nurses to manage diabetic patients on intravenous insulin therapy in hospital wards and intensive care units (ICU). But one of the most important questions - is it safe for inpatients and usable and cost-effective for hospitals?In our study, we included 1,684 glucometer measurements and 72 cycles (1 cycle = 6 days) of the glycemic monitoring system (Guardian Connect Enlite, Medtronic) in patients on intravenous insulin therapy. Most of them were after pancreatectomy. The mean discrepancy between CGM and glucometer values was -4.1%. According to our study, 77.48% of patients were within the target glycemic range (77.4 mg/dL to 189 mg/dL / 4.3 mmol/L to 10.5 mmol/L), hypoglycemia below 50.4 mg/dL / 2.3 mmol/L was recorded in only 2 cases out of 1648. Results confirm safety and usefulness of glucose monitoring systems in-hospital even in the most severe patients, such as those who were in several days after total pancreatectomy. We compared the cost glucose control using of CGM during of one cycle (6 days) and cost glucose control using glucometer during the same period (6 days) for diabetic patients on intravenous insulin therapy in the inpatient department. We account the cost of the CGM system, batteries, smartphone, glucometer, lancets, test strips, sensors, gloves, antiseptic wipes.

Results

6 days glucose control for diabetic patients on intravenous insulin therapy of using CGM (including 3 times a day using glucometer for calibration of CGM) cost 5422 rubles (68.2 $ / 62.7 €), using only glucometer (18 times a day) cost 6696 rubles. But the most interesting results were after comparing the nurse's time, spent on the glucose control for diabetic patients on intravenous insulin therapy. During 6 days of using of CGM for this patients nurse spends (including 3 times a day using glucometer for calibration of CGM) - 71 minutes. During 6 days of using only glucometer (18 times a day) for this patients nurse spends - 324 minutes. In that way using of CGM for diabetic patients on intravenous insulin therapy save for nurse 253 minutes (nearly 4 hours) during 6 days. The cost of 1 hour of nurse for private hospitals in Moscow in ICU an average 661 rubles (8.3 $ / 7.65 €), in inpatient department - 544 rubles (6.85 $ / 6.3 €). In finally results show a significant cost-effective of using CGM. Nevertheless, well-known the other one of the most important benefit of using CGM devices is that glycemic control with CGM systems improves the quality of life of patients, because no routine finger pricking is required.

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Blood pressure response to stress tests does not reflect blood pressure variability and degree of cardiovascular involvement in young hypertensives

The aim of the study was to assess the clinical value of blood pressure response to stress tests and to study its relationship with ambulatory blood pressure monitoring, daily blood pressure variability and hypertensive complications. Cold pressor test for 2 min, hand grip test at 25% of maximal voluntary contraction for 5 min and orthostatism were performed in 223 young men found hypertensive (BP systolic > 140 mmHg and/or diastolic > 90 mmHg) at the military service recruitment check-up. On the basis of ECG and fundoscopic examination, each patient was attributed a score of target organ damage. All patients underwent non-invasive 24-h blood pressure monitoring and 169 patients underwent echocardiographic examination. Hypertension was confirmed in 54.2% of the subjects at ambulatory monitoring. No correlation was found between blood pressure response to stress tests and ambulatory blood pressure, daily blood pressure variability, target organ damage and left ventricular mass. Night-time ambulatory blood pressure were correlated with posterior wall thickness/ventricular diastolic internal diameter ratio (r = 0.26, P < 0.001). A negative correlation was found between the office-daytime blood pressure difference and systolic and diastolic response to orthostatic test (r = -0.309, P < 0.0001 for systolic blood pressure and r = -0.433, P < 0.0001 for diastolic blood pressure) and between supine office blood pressure and blood pressure response to orthostatism (r = -0.186. P = 0.013 for systolic blood pressure and r = -0.442, P < 0.0001 for diastolic blood pressure).(ABSTRACT TRUNCATED AT 250 WORDS)