• Clinical Evidence

Hyperglycemia Management in the Hospital: The Pharmacist’s Role

Setting: 71-bed full-service community hospital.

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.

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.

References

Authors

Melody Eppley, PharmD; Garrett Serr, PharmD.

Source

Published in Hospital Pharmacy, Volume 44, Number 7, p594-603.

Year

2009

Quick navigation
Objective
Setting
Results
Conclusions
References
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.

References

Authors

Melody Eppley, PharmD; Garrett Serr, PharmD.

Source

Published in Hospital Pharmacy, Volume 44, Number 7, p594-603.

Year

2009

Short and Sweet Headlines are Best!

Related posts

Image
  • Clinical Evidence

Using EndoTool to Optimize Insulin Management in DKA Patients with Renal Impairment

Using EndoTool to Optimize Insulin Management in DKA Patients with Renal Impairment

The objective of this study was to evaluate the impact of renal insufficiency on hypoglycemia rates in patients treated for Diabetic Ketoacidosis (DKA) utilizing a computerized insulin dosing algorithm.
Image
  • Clinical Evidence

Achieving Optimal Glucose Control in Critical Care Units at Atrium Health

20 minute read

Achieving Optimal Glucose Control in Critical Care Units at Atrium Health

The objective of this study was to evaluate the impact of different blood glucose (BG) target ranges for IV insulin infusions on inpatient glucose metrics, specifically focusing on hypo and hyperglycemic events, duration of IV insulin therapy, and length of stay (LOS) in the hospital.
Image
  • Clinical Evidence

Atrium Health Lowers Hospital Stay for DKA Patients, Yielding $12 Million in Savings

Atrium Health Lowers Hospital Stay for DKA Patients, Yielding $12 Million in Savings

To compare the effectiveness of EndoTool IV in reducing hospital LOS and hypoglycemia rates compared to standard insulin infusion protocols.
Get in Touch

Ready to get started?

Fill in your details and one of our friendly team members will be in touch to show you how easily EndoTool can support your hospital.

"*" indicates required fields

Name*
This field is for validation purposes and should be left unchanged.