An Electronic Health Record-Integrated Computerized Intravenous Insulin Infusion Protocol: Clinical Outcomes and in Silico Adjustment
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- Title
- An Electronic Health Record-Integrated Computerized Intravenous Insulin Infusion Protocol: Clinical Outcomes and in Silico Adjustment
- Authors
- PARK, SUNG WOON; LEE, SEUNGHYUN; CHA, WON CHUL; HUR, KYU YEON; KIM, JAE HYUN; LEE, MOON-KYU; PARK, SUNG-MIN; JIN, SANG-MAN
- Date Issued
- 2020-02
- Publisher
- KOREAN DIABETES ASSOC
- Abstract
- Background: We aimed to describe the outcome of a computerized intravenous insulin infusion (CII) protocol integrated to the electronic health record (EHR) system and to improve the CII protocol in silico using the EHR-based predictors of the outcome. Methods: Clinical outcomes of the patients who underwent the CII protocol between July 2016 and February 2017 and their matched controls were evaluated. In the CII protocol group (n =91), multivariable binary logistic regression analysis models were used to determine the independent associates with a delayed response (taking >= 6.0 hours for entering a glucose range of 70 to 180 mg/dL). The CII protocol was adjusted in silico according to the EHR-based parameters obtained in the first 3 hours of CII. Results: Use of the CII protocol was associated with fewer subjects with hypoglycemia alert values (P=0.003), earlier (P=0.002), and more stable (P=0.017) achievement of a glucose range of 70 to 180 mg/dL. Initial glucose level (P=0.001), change in glucose during the first 2 hours (P=0.026), and change in insulin infusion rate during the first 3 hours (P= 0.029) were independently associated with delayed responses. Increasing the insulin infusion rate temporarily according to these parameters in silico significantly reduced delayed responses (P < 0.0001) without hypoglycemia, especially in refractory patients. Conclusion: Our CII protocol enabled faster and more stable glycemic control than conventional care with minimized risk of hypoglycemia. An EHR-based adjustment was simulated to reduce delayed responses without increased incidence of hypoglycemia.
- URI
- https://oasis.postech.ac.kr/handle/2014.oak/101223
- DOI
- 10.4093/dmj.2018.0227
- ISSN
- 2233-6079
- Article Type
- Article
- Citation
- DIABETES & METABOLISM JOURNAL, vol. 44, no. 1, page. 56 - 66, 2020-02
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