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Continuous insulin monitoring does not raise hospital costs

n the year 2000. Before surgery, patients with diabetes were started on an IV insulin infusion with glucose monitoring every one to two hours. Their goal was to maintain glucose levels between 120 and 200 milligrams per deciliter (mg/dl) of blood (the safe, or "target" range for people with diabetes) throughout the patient's surgery and for at least 48 hours after. The protocol required training for and cooperation from surgical teams, anesthesiologists and nursing staff. As part of the protocol, an endocrinologist assisted with glucose management.

The patients admitted under the IGCP, were compared to 81 patients with diabetes who underwent CABG surgery at the Medical Center in 1999 who were cared for using conventional methods, with glucose monitoring every four to six hours.

The IGCP group showed significantly better glycemic control than the conventional group. Average glucose for patients in the protocol was 183.5 mg/dl. Patients receiving conventional treatment had mean glucose of 241.7. Overall cost of treatment for patients on the IGCP was $21,076 compared to $21,422 for patients in conventional treatment.

Although the data was not statistically significant due to small sample size, patients on the IGCP showed a trend toward shorter length of stay in the hospital and fewer deep sternal wound infections compared to patients with conventional treatment. This supports earlier research showing that better glycemic control improves outcomes for patients with diabetes. Although the study suggests it, it was not clear that expenses incurred by the protocol - insulin infusions, frequent glucose monitoring and the need for an endocrinologist consultation - were offset by the avoidance of costly complications like treatment for infection.

"Although more and more evidence supports the role of better glycemic control in intensive care situations for people with diabetes, most hospitals are not currently providing tight glycemic control.
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12-Apr-2004


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