Login Register Cart 0
Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Computer-Based versus Paper-Based Insulin Infusion Algorithms in Diabetic Ketoacidosis

Author(s): Moustafa Younis*, John Pham, Hussein Asad and Majdi S. Hamarshi

Volume 16, Issue 6, 2020

Page: [628 - 634] Pages: 7

DOI: 10.2174/1573399815666190712191932

Price: $65

Abstract

Background: Paper-based and computer-based insulin infusion algorithms facilitate appropriate glycemic therapy. The data comparing these algorithms in the management of diabetic ketoacidosis in the intensive care unit (ICU) setting are limited. We aimed to determine the differences in time to diabetic ketoacidosis resolution and incidence of hypoglycemia between computer and paper-based insulin infusion.

Methods: Single-institution retrospective review of patients admitted to the ICU with diabetic ketoacidosis between 4/1/2015 and 7/20/2018. Our institution introduced computer-based insulin infusion (Glucommander) to the intensive care unit on 3/28/2016. Patients were grouped into either paper-based group (preintervention) or a computer-based group (postintervention). Summary and univariate analyses were performed.

Results: A total of 620 patients (paper-based=247; computer-based=373) with a median (IQR) age of 40 (26-56) years were included; 46% were male. Patients in the computer-based group were significantly older (p=0.003); otherwise, there were no significant differences in gender, race, body mass index and HbA1c. The mean (±SD) time to diabetic ketoacidosis resolution in the computer-based group was significantly lower than the paper-based group (p=0.02). The number of patients in the paper-based group who developed severe hypoglycemia (<50 mg/dl) was significantly higher {8% vs 1%; p<0.0001}.

Conclusion: Our analyses demonstrate statistically significant decreases in time to DKA resolution and hypoglycemic events in DKA patients who were managed using a computer-based insulin infusion algorithm providing a more effective and safer option when compared to paper-based insulin infusion.

Keywords: Diabetic ketoacidosis, insulin, glucommander, hypoglycemia, algorithm, diabetes.

[1]
Hellman R. Patient safety and inpatient glycemic control: translating concepts into action. Endocr Pract 2006; 12(Suppl. 3): 49-55.
[http://dx.doi.org/10.4158/EP.12.S3.49] [PMID: 16905517]
[2]
Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 2009; 32(6): 1119-31.
[http://dx.doi.org/10.2337/dc09-9029] [PMID: 19429873]
[3]
Ullal J, McFarland R, Bachand M, Aloi J. Use of a computer-based insulin infusion algorithm to treat diabetic ketoacidosis in the emergency department. Diabetes Technol Ther 2016; 18(2): 100-3.
[http://dx.doi.org/10.1089/dia.2015.0215] [PMID: 26783996]
[4]
Davidson PC, Steed RD, Bode BW. Glucommander: a computer-directed intravenous insulin system shown to be safe, simple, and effective in 120,618 h of operation. Diabetes Care 2005; 28(10): 2418-23.
[http://dx.doi.org/10.2337/diacare.28.10.2418] [PMID: 16186273]
[5]
White NH, Skor D, Santiago JV. Practical closed-loop insulin delivery. A system for the maintenance of overnight euglycemia and the calculation of basal insulin requirements in insulin-dependent diabetics. Ann Intern Med 1982; 97(2): 210-3.
[http://dx.doi.org/10.7326/0003-4819-97-2-210] [PMID: 7103278]
[6]
Ullal J, Aloi JA, Reyes-Umpierrez D, et al. Comparison of computer-guided versus standard insulin infusion regimens in patients with diabetic ketoacidosis. J Diabetes Sci Technol 2018; 12(1): 39-46.
[http://dx.doi.org/10.1177/1932296817750899] [PMID: 29291648]
[7]
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009; 32(7): 1335-43.
[http://dx.doi.org/10.2337/dc09-9032] [PMID: 19564476]
[8]
Fort A, Narsinghani U, Bowyer F. Evaluating the safety and efficacy of Glucommander, a computer-based insulin infusion method, in management of diabetic ketoacidosis in children, and comparing its clinical performance with manually titrated insulin infusion. J Pediatr Endocrinol Metab 2009; 22(2): 119-25.
[http://dx.doi.org/10.1515/JPEM.2009.22.2.119] [PMID: 19449669]
[9]
Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care 2001; 24(1): 131-53.
[http://dx.doi.org/10.2337/diacare.24.1.131] [PMID: 11194218]
[10]
Bouw JW, Campbell N, Hull MA, Juneja R, Guzman O, Overholser BR. A retrospective cohort study of a nurse-driven computerized insulin infusion program versus a paper-based protocol in critically ill patients. Diabetes Technol Ther 2012; 14(2): 125-30.
[http://dx.doi.org/10.1089/dia.2011.0130] [PMID: 22011007]
[11]
Egi M, Bellomo R, Stachowski E, et al. Hypoglycemia and outcome in critically ill patients. Mayo Clin Proc 2010; 85(3): 217-24.
[http://dx.doi.org/10.4065/mcp.2009.0394] [PMID: 20176928]
[12]
Aloi J, Bode BW, Ullal J, et al. Comparison of an electronic glycemic management system versus provider-managed subcutaneous basal bolus insulin therapy in the hospital setting. J Diabetes Sci Technol 2017; 11(1): 12-6.
[http://dx.doi.org/10.1177/1932296816664746] [PMID: 27555601]
[13]
Devalia B. Adherance to protocol during the acute management of diabetic ketoacidosis: would specialist involvement lead to better outcomes? Int J Clin Pract 2010; 64(11): 1580-2.
[http://dx.doi.org/10.1111/j.1742-1241.2010.02348.x] [PMID: 20846206]
[14]
Solá E, Garzón S, García-Torres S, Cubells P, Morillas C, Hernández-Mijares A. Management of diabetic ketoacidosis in a teaching hospital. Acta Diabetol 2006; 43(4): 127-30.
[http://dx.doi.org/10.1007/s00592-006-0227-1] [PMID: 17211563]
[15]
Singh RK, Perros P, Frier BM. Hospital management of diabetic ketoacidosis: are clinical guidelines implemented effectively? Diabet Med 1997; 14(6): 482-6.
[http://dx.doi.org/10.1002/(SICI)1096-9136(199706)14:6<482:AID-DIA371>3.0.CO;2-A] [PMID: 9212315]
[16]
Haupt MT, Bekes CE, Brilli RJ, et al. Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. Crit Care Med 2003; 31(11): 2677-83.
[http://dx.doi.org/10.1097/01.CCM.0000094227.89800.93] [PMID: 14605541]
[17]
Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002; 288(17): 2151-62.
[http://dx.doi.org/10.1001/jama.288.17.2151] [PMID: 12413375]

Rights & Permissions Print Cite
Article Metrics
34
© 2024 Bentham Science Publishers | Privacy Policy