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- Title
An Electronic Health Record-Integrated Computerized Intravenous Insulin Infusion Protocol: Clinical Outcomes and in Silico Adjustment.
- Authors
Sung Woon Park; Seunghyun Lee; Won Chul Cha; Kyu Yeon Hur; Jae Hyeon Kim; Moon-Kyu Lee; Sung-Min Park; Sang-Man Jin
- 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.
- Subjects
INTRAVENOUS therapy; MEDICAL protocols; ELECTRONIC health records; GLUCOSE tolerance tests; LOGISTIC regression analysis; GLUCOSE clamp technique; GLYCEMIC control
- Publication
Diabetes & Metabolism Journal, 2020, Vol 44, Issue 1, p56
- ISSN
2233-6079
- Publication type
Article
- DOI
10.4093/dmj.2018.0227