Journal of diabetes science and technology · 2026
Multicenter Comparison of Computerized Insulin Sensitivity Coefficient and Paper-Based Intravenous Insulin Protocols.
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Janowski Amy K, Patel Nandini, Ware Lydia R, Dube Kevin M, Kovacevic Mary P, Lupi Kenneth E, Tom Andrew, Roberts Russel J, Bane Anne, Szumita Paul M, Palermo Nadine E, DeGrado Jeremy R
Аннотация
INTRODUCTION: Computerized intravenous (IV) insulin infusion calculators may offer a safe and efficacious means of achieving glycemic control. Historically, our health system utilized various paper-based IV insulin infusion protocols but transitioned to a computerized insulin infusion calculator protocol based on the insulin sensitivity coefficient (ISC) in 2024. The objective of this study was to compare the safety and efficacy of the computerized ISC-based insulin infusion calculator protocol with previous protocols.
METHODS: This was a pre-post intervention analysis of critically ill adult patients initiated on a paper-based insulin infusion across 13 institutions from March 2023 to May 2023 for pre-analysis and patients on a computerized, ISC-based insulin infusion from November 2024 to December 2024 for post-analysis. The primary outcome was the percentage of blood glucose levels within target range (80-180 mg/dL). Secondary outcomes included rates of hyperglycemia (>200 mg/dL), severe hyperglycemia (>250 mg/dL), hypoglycemia (<70 mg/dL), and severe hypoglycemia (<54 mg/dL).
RESULTS: In total, 207 and 237 patients were included in the pre- and post-intervention groups, respectively. For the primary outcome, 4610 of 6313 (73%) and 6163 of 7870 (78.3%) of blood glucose values were in range in the pre- and post-intervention groups, respectively (P < .01). There was no difference in severe hypoglycemia (0.2% vs 0.1%, P = .24), but rates of hyperglycemia (16.6% vs 12.6%, P < .01), severe hyperglycemia (5.7% vs 4.0%, P < .01), and hypoglycemia (0.7% vs 0.2%, P < .01) were higher in the pre-intervention group.
CONCLUSIONS: A computerized ISC-based insulin infusion protocol resulted in more blood glucose values in target range and lower rates of hypoglycemia compared with paper-based protocols.
METHODS: This was a pre-post intervention analysis of critically ill adult patients initiated on a paper-based insulin infusion across 13 institutions from March 2023 to May 2023 for pre-analysis and patients on a computerized, ISC-based insulin infusion from November 2024 to December 2024 for post-analysis. The primary outcome was the percentage of blood glucose levels within target range (80-180 mg/dL). Secondary outcomes included rates of hyperglycemia (>200 mg/dL), severe hyperglycemia (>250 mg/dL), hypoglycemia (<70 mg/dL), and severe hypoglycemia (<54 mg/dL).
RESULTS: In total, 207 and 237 patients were included in the pre- and post-intervention groups, respectively. For the primary outcome, 4610 of 6313 (73%) and 6163 of 7870 (78.3%) of blood glucose values were in range in the pre- and post-intervention groups, respectively (P < .01). There was no difference in severe hypoglycemia (0.2% vs 0.1%, P = .24), but rates of hyperglycemia (16.6% vs 12.6%, P < .01), severe hyperglycemia (5.7% vs 4.0%, P < .01), and hypoglycemia (0.7% vs 0.2%, P < .01) were higher in the pre-intervention group.
CONCLUSIONS: A computerized ISC-based insulin infusion protocol resulted in more blood glucose values in target range and lower rates of hypoglycemia compared with paper-based protocols.