An Electronic Health Record-Integrated Computerized Intravenous Insulin Infusion Protocol: Clinical Outcomes and Adjustment.

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 (=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 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 (=0.003), earlier (=0.002), and more stable (=0.017) achievement of a glucose range of 70 to 180 mg/dL. Initial glucose level (=0.001), change in glucose during the first 2 hours (=0.026), and change in insulin infusion rate during the first 3 hours (=0.029) were independently associated with delayed responses. Increasing the insulin infusion rate temporarily according to these parameters significantly reduced delayed responses (<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.