Journals Information
Advances in Diabetes and Metabolism(CEASE PUBLICATION) Vol. 1(1), pp. 29 - 35
DOI: 10.13189/adm.2013.010106
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Use of a Subcutaneous Insulin Computerized GlucoStabilizer™ Program on Glycemic Control in the Intensive Care Setting: a Retrospective Data Analysis
Serena Harris PharmD BCPS1, Sarah A. Nisly PharmD BCPS2,3, Laura Aykroyd PharmD BCPS2, Joni Carroll RN MSN CDE4, Brian Ulmer MD5, Michael Waddell MD6, Samuel Flanders MD7, Rattan Juneja MBBS MD MRCP8,*
1 Department of Pharmacy Spectrum Health, 100 Michigan North East, Grand Rapids, MI49503, USA
2 Department of Pharmacy, Indiana University Health, 1701 North Senate Boulevard, Indianapolis, IN 46202, USA
3 Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave, Indianapolis, IN 46208, USA
4 Indiana University Health, 550 University Boulevard, Indianapolis, IN 46202, USA
5 Department of Medicine, Indiana University Health, 1801 North Senate Boulevard Indianapolis, IN 46202, USA
6 Department of Medicine, St. Francis Hospital, 8111 South Emerson Avenue, Indianapolis, IN 46237, USA
7 Department of Pediatrics, Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA
8 Department of Medicine, Indiana University School of Medicine, 541 Clinical Drive, Indianapolis, IN 46202, USA
ABSTRACT
Background: Despite guidelines that recommend strongly against Sliding Scale Insulin (SSI) it continues to be the most commonly insulin regimen used in hospitals to treat hyperglycemia. In addition to being reactionary to a glucose that has already increased, SSI offers practical challenges in the randomness of the doses of insulin prescribed and often a disconnect with glucose testing that should be occurring in congruence to the insulin dosing. While many clinical trials have shown improved glycemic control in critical care patients receiving intravenous insulin; few studies have demonstrated the efficacy of subcutaneous (SQ) insulin in this setting. In this study, we have evaluated the safety and efficacy of SQ insulin administration utilizing a computerized program, the Clarian GlucoStabilizer™ Subcutaneous Program (CGS-SQ) in the intensive care unit (ICU). This program is designed to overcome some of the most common barriers of SQ insulin delivery, those of dose calculation and timing. Methods: A computerized SQ insulin delivery program -The Clarian GlucoStabilizer™ Subcutaneous Program (CGS-SQ)- was made available to ICU practitioners, facilitating standardized calculation of insulin doses and incorporating reminder alarms for blood glucose (BG) testing. This program used three defaults Insulin Sensitivity Factors (ISF) and Insulin to Carbohydrate Ratios (CR) to calculate insulin doses. Additionally, there is an option for practitioner determined ISF and ICR. Patients, aged ≥ 18 years, initiated on the CGS-SQ and admitted to the (ICU) were eligible for inclusion in this retrospective evaluation. Patients were divided into four groups based on initial insulin sensitivity factor (ISF) and carbohydrate ratio (CR). Three of the groups used a default ISF and CR; ISF 60, CR 15; ISF 30, CR 10 and ISF 15, CR 8. These groups were compared with those where the practitioner specified an individualized ISF and CR, referred to as PDS (practitioner defined setting). Primary endpoints included: mean glucose, time to target glucose, hyperglycemic and hypoglycemic events. Results: In the 1,384 patients identified, patients initiated with a predefined setting had lower mean glucose compared to patients with PDS (ISF 60, CR 15: 135 mg/dL vs. ISF 30, CR 10: 140 mg/dL vs. ISF 15, CR 8: 134 mg/dL vs. PDS: 143 mg/dL; p < 0.0001). Patients in the default settings had shorter time to target glucose and decreased incidence of hyperglycemia and hypoglycemia. Conclusions: Using a system of computerized prompts with standardization of insulin dose calculation, SQ insulin can be effectively used in the treatment of ICU patients to target BG of 100-150 mg/dL with minimal risk of hypoglycemia.
KEYWORDS
Subcutaneous Insulin, Electronic, Critical Care
Cite This Paper in IEEE or APA Citation Styles
(a). IEEE Format:
[1] Serena Harris PharmD BCPS , Sarah A. Nisly PharmD BCPS , Laura Aykroyd PharmD BCPS , Joni Carroll RN MSN CDE , Brian Ulmer MD , Michael Waddell MD , Samuel Flanders MD , Rattan Juneja MBBS MD MRCP , "Use of a Subcutaneous Insulin Computerized GlucoStabilizer™ Program on Glycemic Control in the Intensive Care Setting: a Retrospective Data Analysis," Advances in Diabetes and Metabolism(CEASE PUBLICATION), Vol. 1, No. 1, pp. 29 - 35, 2013. DOI: 10.13189/adm.2013.010106.
(b). APA Format:
Serena Harris PharmD BCPS , Sarah A. Nisly PharmD BCPS , Laura Aykroyd PharmD BCPS , Joni Carroll RN MSN CDE , Brian Ulmer MD , Michael Waddell MD , Samuel Flanders MD , Rattan Juneja MBBS MD MRCP (2013). Use of a Subcutaneous Insulin Computerized GlucoStabilizer™ Program on Glycemic Control in the Intensive Care Setting: a Retrospective Data Analysis. Advances in Diabetes and Metabolism(CEASE PUBLICATION), 1(1), 29 - 35. DOI: 10.13189/adm.2013.010106.