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Software-Guided Insulin Dosing Decreases Glycemic Variability and Hypoglycemia, while Controlling Hy
Nicole M Saur1, MD, Sharon Holewinski, RN1, Keri O'Brien, RN, JD1, Gail L. Kongable, MSN, FNP2, Stanley A. Nasraway, Jr., MD, FCCM1
1Tufts Medical Center, Boston, MA 2The Epsilon Group, Charlottesville, VA

Background: Hyperglycemia, hypoglycemia and, most recently, glycemic variability (GV) have been shown to predict mortality in the critically ill. We hypothesized that software-guided insulin dosing would be superior to paper-based protocols in controlling these derangements. Methods: A before-and-after pilot study of consecutive cohorts conducted within the context of an existing program intensive insulin in a ten-bed surgical intensive care unit (ICU). A baseline period using a paper protocol-based algorithm was compared with an intervention period during which insulin dosing was determined by a software program. Results: One-hundred and ten patients were treated with the paper protocol and 87 with the software protocol. The mean ICU admission blood glucose (BG) was higher in patients treated with the software protocol than for the paper protocol. Nevertheless, software-based intensive insulin therapy significantly lowered mean BG, sustained greater time within the desired BG target range, achieved less frequent hypoglycemia and diminished GV (Table 1, Figure 1). Conclusion: Surgical ICU patients whose intensive insulin infusions were managed using the software program achieved tighter glycemic control, spent more time in the desired BG range, and achieved decreases in hypoglycemia and GV when compared to patients managed using a paper-based insulin-dosing regimen.


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