Economic outcomes can be improved through better management of blood glucose levels.
Several studies evaluating the cost effectiveness of glycemic control in the critically ill have demonstrated this correlation.
In 2014, Krinsley concluded in a Hospital Practice paper, “Is Glycemic Control of the Critically Ill Cost Effective?” that efforts to improve hyperglycemia and hypoglycemia have a beneficial economic impact.1 He specifically identified considerable financial burden associated with nosocomial infection and increased ICU and hospital length of stay that could be addressed through better glucose control.
An earlier paper by Krinsley, “Cost Analysis of Intensive Glycemic Control in Critically Ill Adult Patients,” published in CHEST, discussed the cost savings demonstrated in a 1,600 patient “before and after” study of intensive glycemia management.2 The study showed that intensive glycemic control in critically ill adult patients resulted in an annualized decrease of costs of $1.3M or $1,580 per patient. These costs were due to decreases in all major categories of resource utilization:
Van den Berghe discussed the comparison of two patient groups in the NICE Sugar study in her 2006 Critical Care Medicine publication, “Analysis of Healthcare Resource Utilization with Intensive Insulin Therapy in Critically Ill Patients.”3 She concluded that the excess cost of the ICU hospitalization in the group whose glucose was not tightly controlled was €2,638 per patient. The lower costs in the group whose glucose was tightly controlled was primarily due to a shorter length of stay in the ICU.
In 2008, Sadhu published a study in Diabetes Care that analyzed the economic outcomes of a clinical program implemented to achieve strict glycemic control with intensive insulin therapy in patients admitted to the ICU.4 The study found that intervention was consistently associated with lower average glucose levels and a reduction in ICU length of stay.
Finally, Aragon discussed the importance of tight glycemic control and the burden associated with frequent fingersticks in her 2006 paper, “Evaluation of Nursing Work Effort and Perceptions About Blood Glucose,” published in the American Journal of Critical Care.5 She found that the costs of taking intermittent blood glucose measurements every two hours, as needed for tight glycemic control, were very high and that easier automated methods for monitoring blood glucose levels would help reduce this burden.
Please click on the links below to review the above articles on the economic impact of CGM in further detail.
- Krinsley J. Is glycemic control of the critically ill cost-effective? Hospital Practice. Oct.2014 Issue 42. Link: http://www.tandfonline.com/doi/abs/10.3810/hp.2014.10.1142#.Vk5JW9An3dk
- Krinsley J. Cost analysis of intensive glycemic control in critically ill adult patients. Chest. 2006,124,644-650. Link: http://www.ncbi.nlm.nih.gov/pubmed/16537863
- Van den Berghe G. Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients. Crit Care Med. 2006 Mar;34(3):612-6. Link: http://www.ncbi.nlm.nih.gov/pubmed/16521256?dopt=Abstract&holding=f1000,f1000m,isrctn
- Sadhu A et al. Economic benefits of intensive insulin therapy in critically ill patients. Diabetes Care. 2008; 31,1556-61. Link: http://www.ncbi.nlm.nih.gov/pubmed/18492943
- Aragon D. Evaluation of nursing work effort and perception about blood glucose control testing in tight glycemic control. Am J Critical Care. 2006, 15(94) 371-377 Link: http://www.ncbi.nlm.nih.gov/pubmed/16823014