Safety and Effectiveness of the Use of an Electronic Glucose Monitoring System Versus Weight-Based Dosing Nomogram for Treatment of Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome in a VA Hospital


This retrospective study compares the safety and effectiveness of an electronic glucose monitoring system (EndoTool) versus paper-based protocols for patients with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) treated with intraveous insulin in the emergency department or an intensive care unit.


159-bed Level 1A tertiary care VA hospital.

  • Incidence of hypoglycemia <70 mg/dL decreased 60.3% with EndoTool, from 0.0604% to 0.024% of patients.
  • Incidence of hyperglycemia >=200 mg/dL decreased 17.4%, from 55.7% to 46.0% of blood glucose readings.
  • Percentage of blood glucose readings within the target range of 140-180 mg/dL increased 60.1% with EndoTool; from 16.3% to 26.1%.
  • Percentage of on-time blood glucose checks increased 53.4% with EndoTool, from 52.6% to 80.7%, indicating improved nursing compliance.

Use of an electronic glucose monitoring system (EndoTool) for managing diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) has potential for increasing the safety and effectiveness of glycemic control and minimizing glycemic variability; it is shown to deliver significantly lower incidence of hypoglycemia and hyperglycemia than paper-based protocols as well as a greater percentage of blood glucose readings in range and improved nursing compliance with blood glucose checks.


Madeline Brown, PharmD; Justin Roberts, PharmD, BCPS; Cole Smith, PharmD, BCPS; Dakota Eash, PharmD Candidate.


Published in Journal of Diabetes Science and Technology.


2023 (Print) 2022 (Online)