Computerised IV insulin gives better control
Pioneering computerised IV insulin administration has shown to better control blood glucose and hypoglycaemia in hospitals, according to research.
EndoTool is a computer-guided blood glucose management system which was trialled in intensive care units at a 900-bed tertiary care teaching hospital.
Participants who went on EndoTool had an indication for IV insulin infusion and operative blood glucose levels greater than 140 mg/dL.
Speaking to Endocrine Today, Dr Robert J. Tanenberg, professor of medicine, division of endocrinology at East Carolina University and medical director of Vidant Medical Center Inpatient Diabetes Program in Greenville, said: “Insulin is one of the most effective but also most dangerous drugs used in the hospital.
“Inpatient hypoglycaemia must be avoided or minimised for optimum care of patients with diabetes and stress hypoglycaemia.
“In critically ill medical and surgical patients, IV insulin therapy is mandatory. Paper protocols have performed relatively well, but linear dose adjustments often lead to hyper/hypoglycaemic states.
“In contradistinction, the EndoTool [electronic glycemic management system] uses mathematical modeling and feedback controls and analyses blood glucose reading trends to develop patient-specific physiologic nonlinear insulin dosing curves based on patient weight, age, diabetes type and glomerular filtration rate.”
Over seven years, more than 400,000 readings were collected from 16,850 patients.
Blood glucose was brought down to 180 mg/dL or lower within 1.5 to 2.3 hours with EndoTool in patients with hypoglycaemia.
There was minimal hypoglycemia: 0.93 per cent of values were less than 70 mg/dL and 0.03 per cent less than 40 mg/dL.
There were year-on-year decreases in hypoglycaemia with a significant reduction in frequency, from 1.04 per cent in 2009 to 0.46 per cent in 2015 (P < .0001).