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Software-guided insulin dosing: tight glycemic control and decreased glycemic derangements in critically ill patients.
Mayo Clin Proc. 2013 Sep; 88(9):920-9.MC

Abstract

OBJECTIVE

To determine whether glycemic derangements are more effectively controlled using software-guided insulin dosing compared with paper-based protocols.

PATIENTS AND METHODS

We prospectively evaluated consecutive critically ill patients treated in a tertiary hospital surgical intensive care unit (ICU) between January 1 and June 30, 2008, and between January 1 and September 30, 2009. Paper-based protocol insulin dosing was evaluated as a baseline during the first period, followed by software-guided insulin dosing in the second period. We compared glycemic metrics related to hyperglycemia, hypoglycemia, and glycemic variability during the 2 periods.

RESULTS

We treated 110 patients by the paper-based protocol and 87 by the software-guided protocol during the before and after periods, respectively. The mean ICU admission blood glucose (BG) level was higher in patients receiving software-guided intensive insulin than for those receiving paper-based intensive insulin (181 vs 156 mg/dL; P=.003, mean of the per-patient mean). Patients treated with software-guided intensive insulin had lower mean BG levels (117 vs 135 mg/dL; P=.0008), sustained greater time in the desired BG target range (95-135 mg/dL; 68% vs 52%; P=.0001), had less frequent hypoglycemia (percentage of time BG level was <70 mg/dL: 0.51% vs 1.44%; P=.04), and showed decreased glycemic variability (BG level per-patient standard deviation from the mean: ±29 vs ±42 mg/dL; P=.01).

CONCLUSION

Surgical ICU patients whose intensive insulin infusions were managed using the software-guided program achieved tighter glycemic control and fewer glycemic derangements than those managed with the paper-based insulin dosing regimen.

Authors+Show Affiliations

Department of Surgery, Boston, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

24001484

Citation

Saur, Nicole M., et al. "Software-guided Insulin Dosing: Tight Glycemic Control and Decreased Glycemic Derangements in Critically Ill Patients." Mayo Clinic Proceedings, vol. 88, no. 9, 2013, pp. 920-9.
Saur NM, Kongable GL, Holewinski S, et al. Software-guided insulin dosing: tight glycemic control and decreased glycemic derangements in critically ill patients. Mayo Clin Proc. 2013;88(9):920-9.
Saur, N. M., Kongable, G. L., Holewinski, S., O'Brien, K., & Nasraway, S. A. (2013). Software-guided insulin dosing: tight glycemic control and decreased glycemic derangements in critically ill patients. Mayo Clinic Proceedings, 88(9), 920-9. https://doi.org/10.1016/j.mayocp.2013.07.003
Saur NM, et al. Software-guided Insulin Dosing: Tight Glycemic Control and Decreased Glycemic Derangements in Critically Ill Patients. Mayo Clin Proc. 2013;88(9):920-9. PubMed PMID: 24001484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Software-guided insulin dosing: tight glycemic control and decreased glycemic derangements in critically ill patients. AU - Saur,Nicole M, AU - Kongable,Gail L, AU - Holewinski,Sharon, AU - O'Brien,Keri, AU - Nasraway,Stanley A,Jr PY - 2013/04/03/received PY - 2013/07/01/revised PY - 2013/07/08/accepted PY - 2013/9/5/entrez PY - 2013/9/5/pubmed PY - 2013/11/14/medline KW - APACHE II KW - Acute Physiology and Chronic Health Evaluation II KW - BG KW - CV KW - GPI KW - GV KW - ICU KW - MAGE KW - blood glucose KW - coefficient of variation KW - glycemic penalty index KW - glycemic variability KW - intensive care unit KW - mean amplitude of glycemic excursions SP - 920 EP - 9 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 88 IS - 9 N2 - OBJECTIVE: To determine whether glycemic derangements are more effectively controlled using software-guided insulin dosing compared with paper-based protocols. PATIENTS AND METHODS: We prospectively evaluated consecutive critically ill patients treated in a tertiary hospital surgical intensive care unit (ICU) between January 1 and June 30, 2008, and between January 1 and September 30, 2009. Paper-based protocol insulin dosing was evaluated as a baseline during the first period, followed by software-guided insulin dosing in the second period. We compared glycemic metrics related to hyperglycemia, hypoglycemia, and glycemic variability during the 2 periods. RESULTS: We treated 110 patients by the paper-based protocol and 87 by the software-guided protocol during the before and after periods, respectively. The mean ICU admission blood glucose (BG) level was higher in patients receiving software-guided intensive insulin than for those receiving paper-based intensive insulin (181 vs 156 mg/dL; P=.003, mean of the per-patient mean). Patients treated with software-guided intensive insulin had lower mean BG levels (117 vs 135 mg/dL; P=.0008), sustained greater time in the desired BG target range (95-135 mg/dL; 68% vs 52%; P=.0001), had less frequent hypoglycemia (percentage of time BG level was <70 mg/dL: 0.51% vs 1.44%; P=.04), and showed decreased glycemic variability (BG level per-patient standard deviation from the mean: ±29 vs ±42 mg/dL; P=.01). CONCLUSION: Surgical ICU patients whose intensive insulin infusions were managed using the software-guided program achieved tighter glycemic control and fewer glycemic derangements than those managed with the paper-based insulin dosing regimen. SN - 1942-5546 UR - https://www.unboundmedicine.com/medline/citation/24001484/Software_guided_insulin_dosing:_tight_glycemic_control_and_decreased_glycemic_derangements_in_critically_ill_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(13)00562-4 DB - PRIME DP - Unbound Medicine ER -