Computer-based Insulin Infusion Protocol Improves Glycemia Control over Manual Protocol

Boord, Jeffrey B.; Sharifi, Mona; Greevy, Robert A.; Griffin, Marie R.; Lee, Vivian K.; Webb, Ty A.; May, Michael; Waitman, Lemuel R.; May, Addison K.; Miller, Randolph A.

doi:10.1197/jamia.m2292

Cited by 89 publications

(114 citation statements)

References 33 publications

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“…Recently, a computer‐based insulin infusion protocol has been introduced in the ICU setting, for which improved glycemic control over the manual protocol was reported 38. Saur et al 39.…”

Section: Insulin Therapy In Patients With Perioperative Hyperglycemiamentioning

confidence: 99%

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Takesue

Tsuchida

2017

Annals of Gastroent Surgery

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Perioperative hyperglycemia is a risk factor for surgical site infections (SSI). Although the recommended target blood glucose level (BG) is 140–180 mg/dL for critically ill patients, recent studies conducted in patients undergoing surgery showed a significant benefit of intensive insulin therapy for the management of perioperative hyperglycemia. The aim of the present review is to evaluate the benefits of strict glycemic control for reducing SSI in gastroenterological surgery. We carried out a post‐hoc analysis of the previously published data from research on the risk factors for SSI. The highest BG within 24 hours after surgery was evaluated. A total of 1555 patients were enrolled in the study. In multivariate analysis, a dose–response relationship between the level of hyperglycemia and the odds of SSI was demonstrated when compared with the reference group (≤150 mg/dL) (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.14–2.49 for 150–200 mg/dL; and OR = 2.15, 95% CI 1.40–3.29 for >200 mg/dL). Unexpectedly, hyperglycemia was not a significant risk factor for SSI among diabetes patients. By contrast, non‐diabetes patients with a BG of >150 mg/dL were found to have increased odds of SSI. In conclusion, a target BG of ≤150 mg/dL is recommended in patients without diabetes who undergo gastroenterological surgery. Additional study is required to determine an optimal target BG in diabetes patients. Because of the risk of hypoglycemia, a conventional protocol is indicated for patients admitted to the general ward where frequent glucose measurement is not assured.

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“…Recently, a computer‐based insulin infusion protocol has been introduced in the ICU setting, for which improved glycemic control over the manual protocol was reported 38. Saur et al 39.…”

Section: Insulin Therapy In Patients With Perioperative Hyperglycemiamentioning

confidence: 99%

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Takesue

Tsuchida

2017

Annals of Gastroent Surgery

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“…[16][17][18] Though intravenous insulin use was associated with better overall glucose control in our study; only about 50% of ICU patients received it on measurement day 1. A recent prospective randomized clinical trial demonstrated superior glycemic control in non-critically ill hospitalized patients with type 2 diabetes with basal/bolus insulin therapy compared to sliding scale insulin alone.…”

Section: Discussionmentioning

confidence: 53%

“…15 There is now emerging consensus that use of continuous insulin infusion given through a standardized protocol is the standard of care to control hyperglycemia in critically ill patients. [16][17][18] Likewise, use of specific hospital insulin regimens that include basal and short-acting insulin with appropriate bedside glucose monitoring and avoiding use of ''sliding scale'' short-acting insulin alone has become recognized as the most effective approach for glucose management in hospitalized patients not requiring intravenous insulin. 4,[19][20][21] The University HealthSystem Consortium (UHC) is an alliance of 97 academic health centers and 153 of their associated hospitals that conducts benchmarking studies on clinical and operational topics with member academic medical centers and develops new programs to improve quality of care, patient safety, and operational, clinical, and financial performance.…”

mentioning

confidence: 99%

Evaluation of hospital glycemic control at US Academic Medical Centers

Boord

Greevy

Braithwaite

et al. 2009

Journal of Hospital Medicine

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OBJECTIVE:To evaluate contemporary hospital glycemic management in US academic medical centers.DESIGN: This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics. RESULTS:In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%-63%) and timely admission laboratory glucose measurement (range, 39%-97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose 110 mg/dL.Hyperglycemia was common, 50% of all patients had !1 glucose measurement !180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days. CONCLUSIONS:Despite frequent insulin use, glucose control was suboptimal.

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“…136 It is advisable to keep glycemia between 140 and 180 mg/dL. 137 Nutrition support should be considered in septic patients and enteral nutrition should be preferred to parenteral one. At the moment, there is not enough evidence to recommend more precise advice regarding doses and timing.…”

Section: Other Measuresmentioning

confidence: 99%

Management of sepsis: from evidence to clinical practice

et al. 2016

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Sepsis is one of the leading causes of death in hospitalized patients and its management involves a lot of specialist. Internist is required to demonstrate his competence since the beginning when the diagnosis is not so easy to be clarified. A rapid clinical suspicion permits a prompt management of the patient that means important mortality reduction. However, it is essential to understand the source of infection and echography represents a rapid, economic, useful and widespread tool with whom Internist should become more and more confident. The following review is a practical guide to manage septic patients according to the most recent literature, underlining aspects of antibiotic therapy, hemodynamic stabilization and supportive therapy. To limit sepsis mortality, a valid Internist should be culturally prepared and especially able to cooperate with other specialists, because a strong enemy requires a strong team.

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Computer-based Insulin Infusion Protocol Improves Glycemia Control over Manual Protocol

Cited by 89 publications

References 33 publications

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Evaluation of hospital glycemic control at US Academic Medical Centers

Management of sepsis: from evidence to clinical practice

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