- Poster presentation
- Open Access
Computer versus paper insulin protocol for managing hyperglycemia in three ICUs
Critical Care volume 19, Article number: P368 (2015)
The purpose of this study was to compare a computer protocol against a paper protocol in managing three domains of glucose control. Hyperglycemia is common in critically ill patients, and their risk of death is associated with hyperglycemia, hypoglycemia, and glucose variability. A safe and effective insulin protocol must minimize hyperglycemia and glucose variability while also avoiding hypoglycemia. Computer-based insulin protocols promise better performance by adjusting to each individual's sensitivity to insulin.
This is a historical cohort study with 759 patients admitted to three ICUs (medical/cardiac, trauma, and neuroscience) at an academic tertiary care hospital. All adult patients from January 2012 to October 2013 on one of two continuous insulin protocols for at least 8 hours were included. At the start of the study period the paper protocol in use (Adult ICU) had a target glucose of 140 to 180 mg/dl and was used for any patient with a glucose higher than 180 mg/dl. In June 2013 this was replaced by a computer-based insulin protocol (EndoTool) that had the same criteria for initiation and had a target glucose of 150 mg/dl. The primary exposure was the insulin protocol, and the primary outcome was performance in maintaining glucose control.
The median glucose in the EndoTool group (141.5 mg/dl) was lower than in the Adult ICU group (159.9 mg/dl) (P < 0.0001). The standard deviation of glucose in the EndoTool group (32.3 mg/ dl) was lower than the Adult ICU group (39.5 mg/dl) (P = 0.0001). The proportion of patients in each group with 10% or higher of measurements at a severe hyperglycemia level (≥200 mg/dl) in the EndoTool group (35.2%) was lower than the Adult ICU group (64.1%) (P < 0.0001). The proportion of patients who had at least one moderate hypoglycemic measurement (<70 mg/dl) was not significantly different between the EndoTool group versus the Adult ICU group (11.73% vs. 9.3%, respectively; P = 0.34). However, there was a higher overall incidence of hypoglycemia in the EndoTool group (5.65 hypoglycemic measurements/100 person-protocol days) compared with the Adult ICU group (3.43/100 person-protocol days) (RR = 1.65, 95% CI = 1.09 to 2.45, P = 0.014). Severe hypoglycemia (<40 mg/dl) was rare, only occurring in 1/179 (0.56%) in the EndoTool group and 4/580 (0.69%) in the Adult ICU group.
Patients on the computer protocol had a lower median glucose, less variability, and less hyperglycemia than patients on the paper protocol. There was a higher risk of moderate but not severe hypoglycemia in the computer group.
About this article
Cite this article
Peckham, A. Computer versus paper insulin protocol for managing hyperglycemia in three ICUs. Crit Care 19, P368 (2015). https://doi.org/10.1186/cc14448
- Glucose Control
- Severe Hypoglycemia
- Tertiary Care Hospital