InsulinAPP application protocol for the inpatient management of type 2 diabetes on a hospitalist-managed ward: a retrospective study

Toyoshima, Marcos Tadashi Kakitani; Brandes, Pedro Henrique Ribeiro; Lauterbach, Gerhard da Paz; Moraes, Jéssica Ribeiro Andrade; Paiva, Edison Ferreira de; Umpiérrez, Guillermo E.; Nery, Márcia; Kondo, Rodrigo Hidd

doi:10.20945/2359-3997000000496

Cited by 4 publications

(1 citation statement)

References 30 publications

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“…O desfecho secundário considerado foi: ocorrência individual de infecção hospitalar, piora da função renal e arritmia atrial de alta resposta ventricular. E mensurou-se também: a) Tempo de internação: período total da internação relacionada a cirurgia cardíaca e as readmissões que ocorreram em até no intervalo de 30 dias da alta hospitalar (125)(126)(127).…”

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Uso de software InsulinAPP para controle glicêmico de pacientes não críticos com hiperglicemia hospitalar e sua relação com desfechos clínicos

Souza¹

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À minha orientadora, Drª Marcia Nery, agradeço a confiança depositada ao longo de todos esses anos. Se hoje me sinto preparado para obter o título de doutor, foi por todas as oportunidades que a senhora me deu. Agradeço pelos ensinamentos e por permitir o desenvolvimento de cada trabalho sem criar barreiras, pelo contrário, sempre incentivando e orientando cada passo. Acima de tudo, agradeço por me ajudar a construir um pensamento crítico, por toda disponibilidade, paciência e por me motivar a seguir em frente mesmo diante de tantas adversidades. A senhora é um grande exemplo de dedicação e competência. Tenho muito orgulho de ser seu orientando! Obrigado por cobrar o melhor de mim e tornar esse sonho uma realidade. Gratidão! Ao professor Dr. Carlos Serrano, por ter abraçado a ideia desde início, acreditado no nosso projeto e com muito empenho foi meu coorientador no doutorado. Nas dificuldades, apontava soluções. Nas dúvidas, trazia experiência. Ao meu amigo Marcos Tadashi, pela paciência, pelo tempo e pelos ensinamentos compartilhados na jornada do desenvolvimento do InsulinAPP. Seu conhecimento acadêmico é notório e me estimulam a não me acomodar na busca constante do saber científico. Sem o seu suporte esse projeto não seria possível. A toda unidade de diabetes, em especial ao grupo de hiperglicemia hospitalar, ao Dr. Simão Lottenberg, que acreditou no projeto logo em seu início e fez a ponte entre a endocrinologia e o Instituto do coração, proporcionando o este estudo; à Dra. Priscilla Cukier, que tem contribuído imensamente para a v implementação do InsulinAPP; a Dra. Ana Cláudia Latronico, uma inspiração para todos nós, jovens pesquisadores, e que deu todo o apoio desde a concepção do protocolo.A toda Unidade de Aterosclerose de Incor, sobretudo na figura do Dr.

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Section: Composição Dos Desfechos Do Estudounclassified

Uso de software InsulinAPP para controle glicêmico de pacientes não críticos com hiperglicemia hospitalar e sua relação com desfechos clínicos

Souza¹

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Electronic Glycemic Management System Improved Glycemic Control and Reduced Complications in Patients With Diabetes Undergoing Coronary Artery Bypass Surgery: A Randomized Controlled Trial

Câmara de Souza,

Toyoshima,

Cukier

et al. 2024

J Diabetes Sci Technol

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Background: In-hospital hyperglycemia poses significant risks for patients with diabetes mellitus undergoing coronary artery bypass graft (CABG) surgery. Electronic glycemic management systems (eGMSs) like InsulinAPP offer promise in standardizing and improving glycemic control (GC) in these settings. This study evaluated the efficacy of the InsulinAPP protocol in optimizing GC and reducing adverse outcomes post-CABG. Methods: This prospective, randomized, open-label study was conducted with 100 adult type 2 diabetes mellitus (T2DM) patients post-CABG surgery, who were randomized into two groups: conventional care (gCONV) and eGMS protocol (gAPP). The gAPP used InsulinAPP for insulin therapy management, whereas the gCONV received standard clinical care. The primary outcome was a composite of hospital-acquired infections, renal function deterioration, and symptomatic atrial arrhythmia. Secondary outcomes included GC, hypoglycemia incidence, hospital stay length, and costs. Results: The gAPP achieved lower mean glucose levels (167.2 ± 42.5 mg/dL vs 188.7 ± 54.4 mg/dL; P = .040) and fewer patients-day with BG above 180 mg/dL (51.3% vs 74.8%, P = .011). The gAPP received an insulin regimen that included more prandial bolus and correction insulin (either bolus-correction or basal-bolus regimens) than the gCONV (90.3% vs 16.7%). The primary composite outcome occurred in 16% of gAPP patients compared with 58% in gCONV ( P < .010). Hypoglycemia incidence was lower in the gAPP (4% vs 16%, P = .046). The gAPP protocol also resulted in shorter hospital stays and reduced costs. Conclusions: The InsulinAPP protocol effectively optimizes GC and reduces adverse outcomes in T2DM patients’ post-CABG surgery, offering a cost-effective solution for inpatient diabetes management.

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Efficacy and safety of basal-bolus insulin at 1:1.5 ratio compared to 1:1 ratio using a weight-based initiation and titration (WIT2) algorithm in hospitalized patients with type 2 Diabetes: a multicenter, randomized, clinical study

Zhang,

Yan,

et al. 2023

Diabetol Metab Syndr

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Background Most studies initiated basal-bolus insulin in a ratio of 1:1 and titrated based on glucose. This study aimed to investigate the effectiveness and safety of a weight-based and ratio of 1:1.5 basal-bolus insulin using an algorithm for both initiation and titration in hospitalized patients with type 2 diabetes (T2D). Methods Hospitalized patients with T2D were randomly assigned to two groups in equal numbers to receive 1:1.5 and 1:1 ratios of basal-bolus insulin using a weight-based algorithm for both initiation and titration. The primary outcome was the time taken to reach the fasting blood glucose (FBG) target and 2-h postprandial blood glucose (2hBG) targets after three meals. The secondary outcome included insulin dosage to achieve glycemic control and the incidence of hypoglycemia during hospitalization. Results 250 patients were screened between October 2021 and June 2022, 220 were randomly grouped, and 182 completed the trial (89 in the 1:1.5 and 93 in the 1:1 groups). The time taken to reach FBG targets was comparable between the two groups (3.4 ± 1.7 vs. 3.0 ± 1.3 days, p = 0.137) within about 3 days. The 2hBG after three meals was shorter in the 1:1.5 group than in the 1:1group (2.9 ± 1.5 vs. 3.4 ± 1.4 days, p = 0.015 for breakfast, 3.0 ± 1.6 vs. 3.6 ± 1.4 days, p = 0.005 for lunch, and 3.1 ± 2.1 vs. 4.0 ± 1.5 days, p = 0.002 for dinner). No significant difference in insulin dosages was found between the two groups at the end of the study. The incidence of hypoglycemia was similar in both groups. Conclusions We demonstrated that fixed dose-ratio basal-bolus insulin at 1:1.5 calculated using a weight-based initiation and titration algorithm was simple, as effective, and safe as ratio at 1:1 in managing T2D in hospitalized patients. Trial Registration ChiCTR 2,100,050,963. Date of registration: September 8, 2021.

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InsulinAPP application protocol for the inpatient management of type 2 diabetes on a hospitalist-managed ward: a retrospective study

Cited by 4 publications

References 30 publications

Uso de software InsulinAPP para controle glicêmico de pacientes não críticos com hiperglicemia hospitalar e sua relação com desfechos clínicos

Uso de software InsulinAPP para controle glicêmico de pacientes não críticos com hiperglicemia hospitalar e sua relação com desfechos clínicos

Electronic Glycemic Management System Improved Glycemic Control and Reduced Complications in Patients With Diabetes Undergoing Coronary Artery Bypass Surgery: A Randomized Controlled Trial

Efficacy and safety of basal-bolus insulin at 1:1.5 ratio compared to 1:1 ratio using a weight-based initiation and titration (WIT2) algorithm in hospitalized patients with type 2 Diabetes: a multicenter, randomized, clinical study

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