Computer-Guided Glucose Management Systems in Treating Patients With Hyperglycemia Who Have Undergone Blood and Bone Marrow Transplant

• Percentage of patients who experience hypoglycemia (defined as at least one blood glucose value less than 70) [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
  Standard statistical methods for rate and proportions will be used to assess binary outcomes, and standard methods for continuous data will be used for quantitative outcomes.
• Percentage of patients who experience severe hypoglycemia (defined as at least one blood glucose value less than 40) [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
  Standard statistical methods for rate and proportions will be used to assess binary outcomes, and standard methods for continuous data will be used for quantitative outcomes.
• Mean time to target range (100-140) [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
  Standard statistical methods for rate and proportions will be used to assess binary outcomes, and standard methods for continuous data will be used for quantitative outcomes.
• Percentage of patients who experience hyperglycemia (defined as at least one blood glucose value greater than 200) 24 hours after initiation of infusion [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
  Standard statistical methods for rate and proportions will be used to assess binary outcomes, and standard methods for continuous data will be used for quantitative outcomes.
• Percentage of patients who experience severe hyperglycemia (defined as at least one blood glucose value greater than 300) 24 hours after initiation of infusion [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
  Standard statistical methods for rate and proportions will be used to assess binary outcomes, and standard methods for continuous data will be used for quantitative outcomes.
• Number of values greater than 200 or less than 70 per patient per day of treatment [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
  Standard statistical methods for rate and proportions will be used to assess binary outcomes, and standard methods for continuous data will be used for quantitative outcomes.
• Glucose variability (defined as standard deviation of individual blood glucose values) [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
  Standard statistical methods for rate and proportions will be used to assess binary outcomes, and standard methods for continuous data will be used for quantitative outcomes.
• Nursing satisfaction evaluated by the Glucose Monitoring Tool Trial Evaluation Form [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
  Standard statistical methods for rate and proportions will be used to assess binary outcomes, and standard methods for continuous data will be used for quantitative outcomes.

• Percentage of patients who experience hypoglycemia (defined as at least one blood glucose value < 70) [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
• Percentage of patients who experience severe hypoglycemia (defined as at least one blood glucose value < 40) [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
• Mean time to target range (101-150) [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
• Percentage of patients who experience hyperglycemia(defined as at least one blood glucose value > 200) 24 hours after initiation of infusion [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
• Percentage of patients who experience severe hyperglycemia (defined as at least one blood glucose value > 300) 24 hours after initiation of infusion [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
• Number of values > 200 or < 70 per patient per day of treatment. [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
• Glucose variability (defined as standard deviation of individual blood glucose values) [ Time Frame: At 6 months ] [ Designated as safety issue: No ]
• Nursing satisfaction evaluated by a survey [ Time Frame: At 6 months ] [ Designated as safety issue: No ]

This clinical trial is studying computer-guided glucose management systems in treating patients with hyperglycemia who have undergone blood and bone marrow transplant. A computer-guided glucose management system (CGGMS) may help manage glucose levels in patients who have undergone blood or bone marrow transplant

PRIMARY OBJECTIVES:

I. To determine whether using CGGMS algorithms in non-critically ill blood and marrow transplant (BMT) adult (age >= 18 years) patients, can control glucose within or close to current University of Washington Medical Center (UWMC) intensive care unit (ICU) targets (100 to 140mg/dl).

SECONDARY OBJECTIVES:

I. Compare two different CGGMS tools to see which reaches glycemic targets and which receives better nursing satisfaction.

OUTLINE: Patients are assigned to 1 of 2 groups.

GROUP I: Patients receive blood glucose management with IV insulin using GlucoCare.

GROUP II: Patients receive blood glucose management with IV insulin using Glucommander.

• Accelerated Phase Chronic Myelogenous Leukemia
• Adult Acute Lymphoblastic Leukemia in Remission
• Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities
• Adult Acute Myeloid Leukemia With Del(5q)
• Adult Acute Myeloid Leukemia With Inv(16)(p13;q22)
• Adult Acute Myeloid Leukemia With t(15;17)(q22;q12)
• Adult Acute Myeloid Leukemia With t(16;16)(p13;q22)
• Adult Acute Myeloid Leukemia With t(8;21)(q22;q22)
• Atypical Chronic Myeloid Leukemia, BCR-ABL1 Negative
• Blastic Phase Chronic Myelogenous Leukemia
• Chronic Eosinophilic Leukemia
• Chronic Myelomonocytic Leukemia
• Chronic Neutrophilic Leukemia
• Chronic Phase Chronic Myelogenous Leukemia
• de Novo Myelodysplastic Syndromes
• Disseminated Neuroblastoma
• Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue
• High Risk Metastatic Gestational Trophoblastic Tumor
• Juvenile Myelomonocytic Leukemia
• Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable
• Nodal Marginal Zone B-cell Lymphoma
• Noncontiguous Stage II Adult Burkitt Lymphoma
• Noncontiguous Stage II Adult Diffuse Large Cell Lymphoma
• Noncontiguous Stage II Adult Diffuse Mixed Cell Lymphoma
• Noncontiguous Stage II Adult Diffuse Small Cleaved Cell Lymphoma
• Noncontiguous Stage II Adult Immunoblastic Large Cell Lymphoma
• Noncontiguous Stage II Adult Lymphoblastic Lymphoma
• Noncontiguous Stage II Grade 1 Follicular Lymphoma
• Noncontiguous Stage II Grade 2 Follicular Lymphoma
• Noncontiguous Stage II Grade 3 Follicular Lymphoma
• Noncontiguous Stage II Mantle Cell Lymphoma
• Noncontiguous Stage II Marginal Zone Lymphoma
• Noncontiguous Stage II Small Lymphocytic Lymphoma
• Previously Treated Myelodysplastic Syndromes
• Recurrent Adult Acute Myeloid Leukemia
• Recurrent Adult Burkitt Lymphoma
• Recurrent Adult Diffuse Large Cell Lymphoma
• Recurrent Adult Diffuse Mixed Cell Lymphoma
• Recurrent Adult Diffuse Small Cleaved Cell Lymphoma
• Recurrent Adult Hodgkin Lymphoma
• Recurrent Adult Immunoblastic Large Cell Lymphoma
• Recurrent Adult Lymphoblastic Lymphoma
• Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma
• Recurrent Grade 1 Follicular Lymphoma
• Recurrent Grade 2 Follicular Lymphoma
• Recurrent Grade 3 Follicular Lymphoma
• Recurrent Malignant Testicular Germ Cell Tumor
• Recurrent Mantle Cell Lymphoma
• Recurrent Marginal Zone Lymphoma
• Recurrent Mycosis Fungoides/Sezary Syndrome
• Recurrent Small Lymphocytic Lymphoma
• Refractory Chronic Lymphocytic Leukemia
• Refractory Multiple Myeloma
• Relapsing Chronic Myelogenous Leukemia
• Secondary Acute Myeloid Leukemia
• Secondary Myelodysplastic Syndromes
• Splenic Marginal Zone Lymphoma
• Stage I Multiple Myeloma
• Stage II Multiple Myeloma
• Stage III Adult Burkitt Lymphoma
• Stage III Adult Diffuse Large Cell Lymphoma
• Stage III Adult Diffuse Mixed Cell Lymphoma
• Stage III Adult Diffuse Small Cleaved Cell Lymphoma
• Stage III Adult Hodgkin Lymphoma
• Stage III Adult Immunoblastic Large Cell Lymphoma
• Stage III Adult Lymphoblastic Lymphoma
• Stage III Chronic Lymphocytic Leukemia
• Stage III Grade 1 Follicular Lymphoma
• Stage III Grade 2 Follicular Lymphoma
• Stage III Grade 3 Follicular Lymphoma
• Stage III Mantle Cell Lymphoma
• Stage III Marginal Zone Lymphoma
• Stage III Multiple Myeloma
• Stage III Small Lymphocytic Lymphoma
• Stage IV Adult Burkitt Lymphoma
• Stage IV Adult Diffuse Large Cell Lymphoma
• Stage IV Adult Diffuse Mixed Cell Lymphoma
• Stage IV Adult Diffuse Small Cleaved Cell Lymphoma
• Stage IV Adult Hodgkin Lymphoma
• Stage IV Adult Immunoblastic Large Cell Lymphoma
• Stage IV Adult Lymphoblastic Lymphoma
• Stage IV Chronic Lymphocytic Leukemia
• Stage IV Grade 1 Follicular Lymphoma
• Stage IV Grade 2 Follicular Lymphoma
• Stage IV Grade 3 Follicular Lymphoma
• Stage IV Mantle Cell Lymphoma
• Stage IV Marginal Zone Lymphoma
• Stage IV Small Lymphocytic Lymphoma

• Other: computer-assisted intervention
  Undergo blood glucose management using GlucoCare
• Other: computer-assisted intervention
  Undergo blood glucose management using Glucommander

• Experimental: Group I (GlucoCare)
  Patients receive blood glucose management with IV insulin using GlucoCare.
  Intervention: Other: computer-assisted intervention
• Experimental: Group II (Glucommander)
  Patients receive blood glucose management with IV insulin using Glucommander.
  Intervention: Other: computer-assisted intervention

Inclusion Criteria:

• Post-transplant adult patients (age >= 18 years) on the BMT Service at UWMC

• Requiring insulin secondary to:

  • Known history of (h/o) type 2 diabetes mellitus
  • Two blood sugar values > 180 (point of care and/or am lab glycemia)
  • One blood sugar value > 250 (point of care or AM lab glycemia)

Exclusion Criteria:

• Critically ill patients (intensive care unit [ICU] admissions)
• Terminally ill patients
• Eastern Cooperative Oncology Group (ECOG) performance status > 3
• Previous type 1 diabetes mellitus
• Cognitively impaired patients, unable to consent
• Women of childbearing potential not on 2 different forms of contraception