Johns Hopkins University, Baltimore, MD, USA.
Pump Avenue Foundation, Scottsdale, AZ, USA.
J Diabetes Sci Technol. 2023 May;17(3):635-641. doi: 10.1177/19322968231163584. Epub 2023 Mar 22.
The primary objective of this analysis was to compare the safety and efficacy of a novel computerized insulin infusion protocol (CIIP), the Lalani Insulin Infusion Protocol (LIIP), with an established CIIP, Glucommander.
We conducted a 10-month retrospective analysis of 778 patients in whom LIIP was used (August 18, 2020 to June 25, 2021) at six HonorHealth Hospitals in the Phoenix metropolitan area. These data were compared with Glucommander that was used at those same hospitals from January 1, 2018 to August 17, 2020, n = 4700. Primary end points of the project included average time to euglycemia and average time in hyperglycemia (>180 mg/dL) and hypoglycemia (<70 mg/dL). Additional subgroup analysis was done to evaluate CIIP performance in patients in whom maintenance of euglycemia was more challenging.
The LIIP had a faster time to euglycemia (191 vs 222 minutes, < .001) and similar time in hypoglycemia (2.79 vs 2.76 minutes, = .50) for all patients, when compared with Glucommander. Similar observations were made for the following subgroups: diabetic ketoacidosis/hyperosmolar hyperglycemic state (DKA/HHS) patients, COVID-19 patients, patients on steroids, patients with ≥60 glomerular filtration rate (GFR), patients with renal insufficiency, and patients with sepsis.
The LIIP is a safe and effective CIIP in managing intravenous insulin infusion rates. Utilization of LIIP resulted in reduced time to euglycemia, < .001, when compared with Glucommander and did not cause increased hypoglycemia during the project period. Contributing factors to the success of LIIP may include improved clinical workflow, learnability and ease of use, compatibility with the Epic electronic health record (EHR), and its unique, dynamic and adaptive algorithm.
本分析的主要目的是比较新型计算机胰岛素输注方案（CIIP），即拉兰尼胰岛素输注方案（LIIP）与已确立的 CIIP，Glucommander 的安全性和疗效。
我们对 2020 年 8 月 18 日至 2021 年 6 月 25 日期间在凤凰城大都市区的六家 HonorHealth 医院使用 LIIP 的 778 例患者进行了为期 10 个月的回顾性分析。这些数据与 2018 年 1 月 1 日至 2020 年 8 月 17 日期间在同一医院使用的 Glucommander 进行了比较，n = 4700。该项目的主要终点包括达到正常血糖所需的平均时间、高血糖（>180mg/dL）和低血糖（<70mg/dL）的平均时间。还进行了额外的亚组分析，以评估在维持血糖正常更具挑战性的患者中 CIIP 的性能。
与 Glucommander 相比，LIIP 使所有患者达到正常血糖的时间更快（191 分钟比 222 分钟，<0.001），低血糖时间相似（2.79 分钟比 2.76 分钟，=0.50）。对于以下亚组也观察到了类似的结果：糖尿病酮症酸中毒/高渗高血糖状态（DKA/HHS）患者、COVID-19 患者、使用类固醇的患者、肾小球滤过率（GFR）≥60 的患者、肾功能不全患者和脓毒症患者。
LIIP 是一种安全有效的静脉内胰岛素输注速率管理 CIIP。与 Glucommander 相比，使用 LIIP 可将达到正常血糖的时间缩短，<0.001，并且在项目期间不会导致低血糖增加。LIIP 成功的因素可能包括改善临床工作流程、可学习性和易用性、与 Epic 电子健康记录（EHR）的兼容性以及其独特、动态和自适应算法。
