Comparison of Computer and Paper-Based Protocols for Managing Hyperglycemia in Critical Ill Patients

Case Study

Introduction

The purpose of this study was to compare a computer-based insulin protocol against two paper-based protocols to control hyperglycemia in intensive care unit (ICU) patients. A safe and effective protocol must minimize hyperglycemia and glucose variability while also avoiding hypoglycemia, all of which are associated with increased risk of death. In theory, computer-based protocols that base insulin dosing on the individual patient’s record of response offer better performance by adjusting to each patient’s sensitivity to insulin.

Conclusions

Overall, the computer-based protocol performed better than the paper-based protocols with respect to decreasing mean glucose and avoiding hyperglycemia. There was a higher incidence of moderate but not severe hypoglycemia associated with the computer-based protocol. With the exception of cardiothoracic surgery patients, the computer-based protocol also was associated with decreased glucose variability.

Computer Based vs Paper Based Insulin Protocols

Less Swing Back to Hyperglcemia

Patients on EndoTool had less glucose measurements at a hyperglycemic level, compared to the Adult ICU paper protocol (35.2% vs 64.1%).

Better Hyperglycemia Control

The mean glucose of patients in the EndoTool group was lower than in the Adult ICU paper protocol group (141.5 mg/dL vs 159.9 mg/dL).

No Severe Hypoglycemia

Severe hypoglycemia (<40 mg/dL) did not occur in the EndoTool groups, compared to the Cardiothoracic Surgery paper protocol group (0.34%), and the Adult ICU paper protocol group (0.34%).

Publication Information

Author(s): Andrew T. Peckham

Location: Oregon Health & Science University

Source: Master Thesis of Andrew T. Peckham; OHSU Digital Commons