An Electronic Health Record-Integrated Computerized Intravenous Insulin Infusion Protocol: Clinical Outcomes and in Silico Adjustment
Diabetes & Metabolism Journal
;
: 56-66, 2020.
Article
in English
| WPRIM
| ID: wpr-811148
ABSTRACT
BACKGROUND:
We aimed to describe the outcome of a computerized intravenous insulin infusion (CII) protocol integrated to the electronic health record (EHR) system and to improve the CII protocol in silico using the EHR-based predictors of the outcome.METHODS:
Clinical outcomes of the patients who underwent the CII protocol between July 2016 and February 2017 and their matched controls were evaluated. In the CII protocol group (n=91), multivariable binary logistic regression analysis models were used to determine the independent associates with a delayed response (taking ≥6.0 hours for entering a glucose range of 70 to 180 mg/dL). The CII protocol was adjusted in silico according to the EHR-based parameters obtained in the first 3 hours of CII.RESULTS:
Use of the CII protocol was associated with fewer subjects with hypoglycemia alert values (P=0.003), earlier (P=0.002), and more stable (P=0.017) achievement of a glucose range of 70 to 180 mg/dL. Initial glucose level (P=0.001), change in glucose during the first 2 hours (P=0.026), and change in insulin infusion rate during the first 3 hours (P=0.029) were independently associated with delayed responses. Increasing the insulin infusion rate temporarily according to these parameters in silico significantly reduced delayed responses (P<0.0001) without hypoglycemia, especially in refractory patients.CONCLUSION:
Our CII protocol enabled faster and more stable glycemic control than conventional care with minimized risk of hypoglycemia. An EHR-based adjustment was simulated to reduce delayed responses without increased incidence of hypoglycemia.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Computer Simulation
/
Logistic Models
/
Incidence
/
Medical Records Systems, Computerized
/
Electronic Health Records
/
Glucose
/
Hypoglycemia
/
Insulin
Type of study:
Practice guideline
/
Incidence study
/
Prognostic study
/
Risk factors
Limits:
Humans
Language:
English
Journal:
Diabetes & Metabolism Journal
Year:
2020
Type:
Article
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