Software-guided insulin dosing system improves intrapartum glycemia

  • Dinglas C & al.
  • Am J Obstet Gynecol
  • 8 May 2018

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • The software-guided GlucoStabilizer (Medical Decision Network, LLC, licensed to Indiana University) can improve intrapartum glycemic control in pregestational or gestational diabetes treated with insulin infusion.

Why this matters

  • Maintenance of maternal euglycemia during labor reduces risk for neonatal hypoglycemia, associated morbidities.

Study design

  • GlucoStabilizer is a software-guided insulin dosing system that calculates needed intravenous (IV) insulin dose based on metabolic parameters, target glucose, individual response to insulin.
  • Retrospective cohort study compared laboring patients with diabetes requiring insulin infusion (pregestational or gestational) dosed by standard insulin dosing chart from January 2012 to April 2016 (n=22) vs GlucoStabilizer during May 2016 to December 2017 (n=11) for ≥2 hours.
  • Funding: None disclosed.

Key results

  • Before IV insulin initiation, mean capillary blood glucose was 122.6 mg/dL for GlucoStabilizer and 131.9 mg/dL for standard insulin groups (P=not significant).
  • After IV insulin initiation, mean glucose was 102.9 vs 121.7 mg/dL for GlucoStabilizer vs standard dosing, respectively (P=.02).
  • Percentages achieving blood glucose 70-100 mg/dL predelivery were 81.8% vs 9.1%, respectively (P=.0001).
  • Mean capillary blood glucose 1 hour before delivery was 92.5 vs 122 mg/dL, respectively (P<.05>
  • No episodes of maternal hypoglycemia and no significant differences in neonatal outcomes.

Limitations

  • Small sample size.

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