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- Title
Safety and Effectiveness of a Computerized Subcutaneous Insulin System to Treat Inpatient Hyperglycemia.
- Authors
Golas, Adam; Carroll, Joni; Nelson, Debra; Roudebush, Corbin; Juneja, Rattan; Flanders, Sam
- Abstract
Aim: We evaluated the safety and effectiveness of a computerized subcutaneous insulin system in achieving and maintaining blood glucose (BG) targets in our medical/surgical (Med/Surg) population. Background: Among barriers to implementing strict glycemic control in the Med/Surg unit is the lack of user-friendly tools to standardize and automate insulin protocols. Paper protocols may be ineffective due to irregular or untimely BG testing and error-prone or burdensome insulin dose calculations. Often these protocols administer short-acting insulin without basal insulin coverage (sliding scales), which have been proven to be less effective than basal/bolus insulin. To eliminate the use of sliding scales and to standardize insulin administration hospital-wide, we developed a computerized subcutaneous insulin system. To reduce potential timing errors and missed insulin delivery, the system provides reminder alarms for BG testing and basal/bolus insulin dosing. To prevent calculation error the program calculates a recommended dose based on physician orders for insulin sensitivity factor (default of 30 for weight ≥68 kg and 60 for <68kg), carbohydrate ratio (default of 1:10 for weight ≥68 kg and 1:15 <68kg), and BG target range. If hypoglycemia develops, the program calculates a corrective carbohydrate dose and a follow-up BG test reminder alarm. Numerous safety and record keeping features were incorporated into the system. Results: For the period April to December 2006, 349 patients were treated with this system, with 5,641 BG values obtained. The average BG was 155 ± 64 mg/dl. 67.1% of BG values fell within the clinically acceptable range of 80-180 mg/dl and 49.8% of BG values fell within the range of 80-150 mg/dl. The overall prevalence of hypoglycemia (BG<50 mg/dl) and hyperglycemia (BG≥350 mg/dl) was 0.5% and 1.2%, respectively. Only two insulin dosing errors were reported, both for the dispensing of a wrong insulin type, neither being associated with the operation of the system. Conclusions: Our computerized subcutaneous insulin system offers a safe and effective means of achieving blood glucose targets in Med/Surg patients through a basal/bolus insulin approach.
- Publication
Diabetes, 2007, Vol 56, pA534
- ISSN
0012-1797
- Publication type
Academic Journal