Title:Computer-Based versus Paper-Based Insulin Infusion Algorithms in Diabetic Ketoacidosis
Volume: 16
Issue: 6
Author(s): Moustafa Younis*, John Pham, Hussein Asad and Majdi S. Hamarshi
Affiliation:
- Internal Medicine, University of Missouri-Kansas City, 5100 Rockhill Rd, Kansas City, MO, 64110,United States
Keywords:
Diabetic ketoacidosis, insulin, glucommander, hypoglycemia, algorithm, diabetes.
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.