Objective

This prospective study compares glycemic outcomes before and after implementation of a computer decision support system (EndoTool) for patients receiving intravenous insulin, all of whom were previously treated using a paper algorithm.

Setting

71-bed full-service community hospital.

Results

• Incidence of hypoglycemia <70 mg/dL decreased 80% with EndoTool, from 4% to 0.8% of blood glucose readings.
• Incidence of hyperglycemia >200 mg/dL decreased 54% with EndoTool, from 26% to 12% of blood glucose readings.
• Average time to achieve two consecutive blood glucose readings <150 mg/dL was 4.8 hours with EndoTool.
• Among reported individual cases was a 28-year old female patient admitted with DKA and an initial blood glucose was 566 mg/dL. She received intravenous insulin managed with a paper algorithm, never achieved a blood glucose level lower than 172 mg/dL, and was discharged after 48 hours. This patient was readmitted 20 days later with DKA and an initial blood glucose of 1,001 mg/dL. She received intravenous insulin managed with EndoTool, achieved a blood glucose of 133 mg/dL within 9 hours, and was discharged within 24 hours.
• Among reported individual cases was a 28-year old male patient who arrived to the emergency department with symptoms of polyuria, polydipsia and dehydration, and was admitted with a diagnosis of new-onset diabetes. His blood glucose at 11:00 pm was 444 mg/dL. He received intravenous insulin managed with EndoTool, achieved a blood glucose of 131 mg/dL by 8:00 am the following morning, and was discharged the next day with no further complications.
• Among reported individual cases was a 53-year old male patient admitted for surgical debridement of diabetic foot ulcers. His initial blood glucose was 409 mg/dL. He received intravenous insulin managed with EndoTool and achieved a blood glucose of 142 mg/dL within six hours, at which time it was determined he could be taken to the operating room. He was discharged three days later.

Conclusions

Use of a computer decision support system (EndoTool) achieves markedly better glycemic control than a paper algorithm and, according to nurses, makes transitioning from intravenous to subcutaneous insulin much easier.