Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Diabetes Technol Ther. 2011 Mar;13(3):343-9. doi: 10.1089/dia.2010.0100. Epub 2011 Feb 3.
Glycemic control in patients with acute cardiac conditions is a clinical challenge but may substantially improve patient outcome. The aim of the current study was to evaluate the effect of implementing an automated version of an existing insulin protocol for glucose regulation in the Intensive Cardiac Care Unit (ICCU) on compliance with the protocol and achievement of glycemic targets.
During an 11-month period, data of 667 patients with two or more glucose measurements were evaluated, 425 before and 242 after implementation of the clinical decision support system (CDSS) for glucose control at the Erasmus Medical Center ICCU (Rotterdam, The Netherlands).
After implementation, compliance with the advised measurement time increased from 40% to 52% (P < 0.001), and compliance regarding insulin dosage increased from 49% to 61% (P < 0.001). Also, more patients had a mean glucose level within the target range of 81-126 mg/dL (31% vs. 43% [P = 0.01]). Monthly evaluation identified reasons for protocol noncompliance (e.g., nutritional status and time of day) and will be used to improve the existing CDSS.
The CDSS implementation of an insulin protocol in an ICCU improved compliance, identified targets for further improvement of the protocol, and resulted in improved glucose regulation after implementation.
急性心脏疾病患者的血糖控制是一个临床挑战，但可以显著改善患者的预后。本研究的目的是评估在重症心脏监护病房（ICCU）实施现有胰岛素血糖调节协议的自动化版本对遵守协议和实现血糖目标的影响。
在 11 个月的时间内，评估了在荷兰鹿特丹伊拉斯谟医疗中心 ICCU 实施血糖控制临床决策支持系统（CDSS）前后 667 名患者的两次或多次血糖测量数据，其中 425 名患者在实施前，242 名患者在实施后。
实施后，建议的测量时间的依从性从 40%增加到 52%（P < 0.001），胰岛素剂量的依从性从 49%增加到 61%（P < 0.001）。此外，更多患者的平均血糖水平在 81-126mg/dL 的目标范围内（31%对 43%[P=0.01]）。每月评估确定了违反协议的原因（例如营养状况和时间），并将用于改进现有的 CDSS。
ICCU 中胰岛素协议的 CDSS 实施提高了依从性，确定了进一步改进协议的目标，并在实施后改善了血糖调节。
