Diabetes Metab J.  2020 Feb;44(1):56-66. 10.4093/dmj.2018.0227.

An Electronic Health Record-Integrated Computerized Intravenous Insulin Infusion Protocol: Clinical Outcomes and in Silico Adjustment

• Park SW
• Lee S
• Cha WC
• Hur KY
• Kim JH
• Lee MK
• Park SM
• Jin SM

• KMID: 2470955
• DOI: http://doi.org/10.4093/dmj.2018.0227

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.

Keyword

Computer simulation; Electronic health records; Insulin; Medical records systems, computerized

MeSH Terms

Computer Simulation*
Electronic Health Records
Glucose
Humans
Hypoglycemia
Incidence
Insulin*
Logistic Models
Medical Records Systems, Computerized
Glucose
Insulin

Figure

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  Fig. 1 Patient disposition. CII, computerized intravenous insulin infusion; BG, blood glucose.

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  Fig. 2 The mean glucose levels and insulin doses in good and poor responder groups of the cases using the computerized intravenous insulin infusion protocol during the 48 hours of intravenous insulin infusion. (A) Mean glucose level versus time mapped hourly for the initial 48 hours. (B) Insulin doses versus time mapped hourly for the initial 48 hours. Error bars indicate interquartile range. Numbers below each panel indicate the number of subjects for each time point. In panel B, the insulin infusion rates of good responders include data of a case in which insulin infusion at a rate of 8 to 10 U/hr was abruptly stopped at 44th hour.

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  Fig. 3 Distribution of the time required to reach the target ranges with the computerized intravenous insulin infusion (CII) protocol and additional insulin infusion at early glycemic predicting points. (A) Good responder group. (B) Poor responder group. (C) Reduction in time required to reach a glucose range of 70 to 180 mg/dL. Box and whisker plots indicate median, interquartile range, and range.

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