LAUSR

Learning Objectives: Compared to Paper-Based Insulin Infusion Algorithms (PBIIA), use of Computer-Based Insulin Infusion Algorithms (CBIIA) has resulted in less hypoglycemia episodes and faster time to resolution of hyperglycemia. This is a retrospective study that compares CBIIA vs. PBIIA at our health system seven ICUs. These ICUs varied and included academic, community, tertiary and rural ICUs. The health system adopted GlucommanderTM Enterprise 3.3.1.3 (GMTM) in March of 2016 to replace PBIIA in all the above ICUs. The comparison was made before and after the change to explore the impact of CBIIA on clinical outcomes. The CBIIA was expected to result in less episodes of hypoglycemia (< 80 mg/dL), shorter time to resolution of hyperglycemia (first blood glucose < 180 mg/dL), shorter time to resolution of DKA, shorter time on insulin, and shorter ICU and hospital Length of Stay (LOS). Methods: This was a retrospective study involving 666 patients who were treated with either CBIIA (n=458) or PBIIA (n = 208). We included adult ICU patients who used insulin infusion upon admission for any of the following admission diagnoses; DKA, Hyperosmolar NonKetotic Coma (HONK) and Hyperglycemia. We have built EPIC crystal report that extracted data of interest on all patients. Two of our internal medicine residents have manually validated the EMR generated data before using it for this research. We used chi square, students t test, and Mann Whitney tests as appropriate. Results: Patients from the two groups were similar in basic characteristics including; age, gender, race, BMI, and HbA1c. Proportions of admission diagnoses for DKA, HNKC, and hyperglycemia were 77%, 1%, 22% in CBIIA group and 68%, 5%, 27% in PBIIA group, respectively. Use of CBIIA was associated with lower rates of hypoglycemia during insulin infusion time (14% vs 46%, P < 0.05), and longer time to resolution of hyperglycemia (7.4 ± 4.8 vs 6.1 ± 4.04, P < 0.05). CBIIA use was associated with no change in other outcomes including time to DKA resolution, time on insulin infusion, ICU LOS and hospital LOS. Conclusions: Compared to PBIIA, CBIIA resulted in less hypoglycemia episodes but longer time to resolution of hyperglycemia. CBIIA was similar to PBIIA in terms of other clinical outcomes.