Medical software applications for in-hospital insulin therapy: A systematic review

Abstract

Background In-hospital hyperglycemia (HH) is frequent and related to higher morbidity and mortality. Despite the benefits of HH treatment, glycemic control is often poor and neglected. The use of health applications to support diagnosis and therapy is now incorporated into medical practice. Medical applications for inpatient glycemic management have potential to standardize this handling by the nonspecialist physician. However, related studies are scarce. We aim to evaluate the efficacy in inpatient glycemic control parameters of medical software applications in non-critical care settings. Methods This systematic review on in-hospital insulin applications was performed according to PRISMA guidelines. Data were extracted in triplicate and methodological quality was verified. Specific outcomes of interest were glycemic control efficacy, hypoglycemia risk, length of in-hospital stay, integration with the electronic medical record and healthcare staff acceptance. Results Among the 573 articles initially identified and subsequent revision of the references of each one, seven studies involving six applications were eligible for the review. A better glycemic control was reported with the use of most in-hospital insulin applications in the studies evaluated, but there was no mention of the time to reach the glycemic goal. The risk of hypoglycemia was low. Different reasons influenced the varied acceptance of the use of applications among health professionals. Conclusion The six applications of inpatient insulin therapy in a non-critical care environment proved to be useful and safe compared to the usual management. Medical apps are tools that can help improve the quality of patient care.

Efficacy of a basal insulin dose management smartphone application for controlling fasting blood glucose in patients with type‐2 diabetes mellitus: A single‐centre, randomised clinical study

“…29 Electronic insulin dose calculation tools provide a low-threshold standardised protocol for insulin use and facilitate better control of HH by clinicians. 30 In many studies, the insulin sensitivity index, body weight, BMI, PBG and HbA1c are often used as reference indicators for insulin dose estimation. 15,23,31 For patients with T2DM, body weight reflects insulin sensitivity.…”

“…Currently, there is strong evidence for the benefit of treatment with insulin in HH 29 . Electronic insulin dose calculation tools provide a low‐threshold standardised protocol for insulin use and facilitate better control of HH by clinicians 30 . In many studies, the insulin sensitivity index, body weight, BMI, PBG and HbA1c are often used as reference indicators for insulin dose estimation 15,23,31 .…”

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

“…Computerized physician order entry (CPOE) and clinical decision support (CDSS) systems are important to prevent medication-related errors, to improve quality of care and to increase efficiency in medication administration (19,21). A systematic review analyzed other six applications of insulin therapy in hospitalized patients and these proved to be useful, safe and with improved quality of life for patients, compared to the usual management (14). Many countries continue to use human insulin formulations (NPH/regular) as a standard of care, thus, the InsulinAPP application represents an important clinical tool for the management of patients with T2D.…”

“…Diabetes technology tools including mobile communication technology and computerized insulin administration devices have shown to be promising in improving glycemic control and adherence to insulin therapy (14). Some computerized systems are commercially available to adjust insulin therapy in non-critically ill patients resulting in increased adherence to protocols and reducing hypoglycemic events (15).…”