Local researchers said they have developed a computerized intravenous insulin infusion (CII) protocol integrated into the electronic health record system. The new CII protocol enabled a faster glycemic control with a minimized risk of low blood sugar compared to conventional care, they said.
A research team led by Professor Jin Sang-man at the Samsung Medical Center’s Endocrinology and researchers at Pohang University of Science and Technology released their joint study on the result of an electronic health record-integrated CII protocol in the February issue of Diabetes & Metabolism Journal.
Hyperglycemia, also known as high blood sugar, is associated with poor prognosis and increased mortality in critically ill patients, and it is also a strong risk factor for surgical site infection, according to the researchers.
|Patient disposition. CII, computerized intravenous insulin infusion; BG, blood glucose.|
The research team cited a study of intravenous insulin on 3,116 patients, saying almost one-third of the patients had suffered at least one episode of acute hypoglycemia, or acute low blood sugar, with glucose level falling below 60 mg/dL. Over 8 percent had severe acute hypoglycemia, with glucose dropping below 40 mg/dL.
Although several past studies of CII protocols reported improvement in glycemic control and reduced hypoglycemia, most of them either applied the CII protocols only in the intensive care unit rather than a general ward setting or used frequent use of software to measure glucose levels, the researchers said.
More importantly, most of the past CII protocols targeted a glucose range too low, compared to the recommended range of 140 to 180 mg/dL, which was why they failed to achieve near-elimination of hypoglycemia, they added.
The research team noted that they developed a CII protocol fully integrated into the electronic health record (EHR) system for use in both the general ward and ICU, with a target glucose range of 140 to 180 mg/dL. The study also aimed to improve the CII protocol “in silico,” or in virtual patients on computer simulations, using the electronic health record-based predictors of the outcome.
“Our CII protocol enabled faster and more stable glycemic control than conventional care with minimized risk of hypoglycemia,” the research team concluded.
In silico simulation, the findings showed that temporarily increasing insulin infusion rate based on the glycemic factors using electronic health record-based predictors helped patients achieve glucose targets better, the researchers added.
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