513 Simplified Approach to Incorporating Glycemic Response Within a Continuous Insulin Infusion Algorithm to Improve Incidence of Hypoglycemia in a Single Burn Center

Attaining adequate glycemic control in burn patients has been shown to reduce infection-related mortality. Previous internal evaluation of continuous insulin infusion (CII) use revealed a hypoglycemia rate of 0.6% and an average time within goal glycemic range (70-149 mg/dL) of 13.8 hours / day. A new algorithm, designed to adjust dosage based on glycemic response, underwent six iterations over two years before the final version was implemented. The purpose of this retrospective study was to assess the post-implementation performance of the newly-developed CII algorithm. The current study was powered to detect a 50% reduction in hypoglycemic events, as compared to a pre-implementation historical control. The cohort was 62 percent male with mean age of 54.5+/- 17.4. Sixty five percent had thermal injuries with a median 23.5 (11, 45) percent TBSA. . There were no differences in demographics between groups. Among the 20 records reviewed, 5,239 point-of-care glucoses were assessed. Post implementation, hypoglycemia rates were significantly lower (0.6% vs 0.2%; p < 0.001). There was no difference in median blood glucose between groups (149.9 mg / dL vs. 146.5 mg / dL; p = 0.56). Time spent within goal glycemic range was not significantly different (13.8 vs. 14.7 hours / day; p = 0.23). There were no differences in infection, length of stay, or survival. The consolidation, education, and implementation of a single, dynamic CII algorithm reduced the incidence of hypoglycemia. The authors expect, education and diligence with follow up glucose monitoring will further improve time within goal glycemic range by preventing rebound hyperglycemia.