Zachary Godwin, a junior specialist in the Department of Pathology and Laboratory Medicine, has been selected to receive the National Academy of Clinical Biochemistry Distinguished Abstract Award for a study assessing the impact of accurate glucose measurements on severely burned patients.
Godwin will accept the award at the annual meeting of the American Association for Clinical Chemistry in July. The abstract will be published in the October 2012 issue of the journal Clinical Chemistry.
Godwin worked on the abstract with Nam Tran, assistant professor of pathology and laboratory medicine. Their study found that accurate glucose measurements improve blood-glucose control in patients with severe burns. It was already known that high or low blood-glucose levels, as well as a high variability in blood glucose, contribute to adverse outcomes in intensive care unit patients.
Godwin and Tran hypothesized that inadequate blood-glucose control is due in part to inaccurate hourly glucose measurements performed at the bedside to guide insulin therapy. Existing glucose meters are calibrated to work within a normal range of the percentage of red blood cells, known as hematocrit, found in samples. However, existing meters become more inaccurate as the percentage of hematocrit fluctuates above or below the normal range.
In ICU patients, and especially burn patients, hematocrit tends to be low due to frequent blood loss from testing, surgeries and the injuries themselves. Low levels of hematocrit cause existing glucose meters to falsely report high levels, readings that potentially could lead to more insulin use.
For their study, Godwin and Tran used new glucose meters that automatically correct for hematocrit levels, high or low, to improve accuracy. They randomly assigned burn patients to receive either a traditional or new meter. The patients with the new, autocorrecting devices had more accurate measurements, less insulin requirements, less blood-glucose variability and fewer adverse events stemming from hyperglycemia and hypoglycemia.
In contrast, patients with the traditional meters required more insulin, had more blood-glucose variability, and experienced significantly more adverse events related to hyperglycemia and hypoglycemia.
Godwin and Tran conclude that their findings can apply to other ICU patients, such as surgical trauma patients. In addition, they suggest that accurate glucose measurements can improve the management of diabetic ICU patients who are more susceptible to glycemic excursions.
The study was a pilot supported by the UC Davis Clinical Translational Science Center's Mentored Clinical Research Training Program (MCRTP). Tran is a first-year scholar in the MCRTP, and Godwin is his primary researcher on the study of glycemic control. They plan to expand the study to determine the effect of accurate versus inaccurate blood-glucose measurements on mortality in ICU patients.