Comparison of Computer-Guided Versus Standard Insulin Infusion Regimens in Patients With Diabetic Ketoacidosis
BACKGROUND: This study was performed to investigate the efficacy of Glucommander (GM) (Glytec®), a computer-based algorithm versus standard (paper form-based) continuous insulin infusion (CII) in the treatment of patients with diabetic ketoacidosis (DKA).
METHODS: This was a retrospective multicenter study involving 2665 patients with DKA treated with either GM (n = 1750) or standard protocols (n = 915) across 34 institutions in the United States. GM estimates the rate of CII using an insulin sensitivity factor referred to as a "multiplier" that ranges between 0.01 and 0.03. Outcomes of interest were differences in time to resolve DKA (blood glucose [BG] <200 mg/dL and bicarbonate < 18 mmol/L) and number of hypoglycemic events defined as a BG <70 mg/dl.
RESULTS: Treatment with GM was associated with lower rates of hypoglycemia during the time of the insulin drip (12.9% vs 35%, P = .001), faster time to normalization of blood glucose (9.7 ± 8.9 vs 10.97 ± 10.2 hours, P = .0001) and resolution of metabolic acidosis (13.6 ± 11.8 vs 17.3 ± 19.6 hours, P = .0001), and shorter hospital length of stay (3.2 ± 2.9 vs 4.5 ± 4.8 days, P = .01) compared to standard care. Best treatment outcomes were achieved with an initial multiplier of 0.01 and a glucose target range between 120 and 180 mg/dl.
CONCLUSION: The GM algorithm in DKA treatment resulted in lower rates of hypoglycemia and faster DKA resolution over standard paper-based algorithms. Prospective randomized clinical trials comparing the efficacy and cost of computer-based algorithms versus standard CII regimens are warranted.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2018 |
|---|---|
| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
|---|---|
| Enthalten in: |
Journal of diabetes science and technology - 12(2018), 1 vom: 02. Jan., Seite 39-46 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Ullal, Jagdeesh [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Blood Glucose |
|---|
| Anmerkungen: |
Date Completed 26.07.2019 Date Revised 06.03.2020 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1177/1932296817750899 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM279549865 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM279549865 | ||
| 003 | DE-627 | ||
| 005 | 20231225023228.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2018 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1177/1932296817750899 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0931.xml |
| 035 | |a (DE-627)NLM279549865 | ||
| 035 | |a (NLM)29291648 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Ullal, Jagdeesh |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparison of Computer-Guided Versus Standard Insulin Infusion Regimens in Patients With Diabetic Ketoacidosis |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 26.07.2019 | ||
| 500 | |a Date Revised 06.03.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: This study was performed to investigate the efficacy of Glucommander (GM) (Glytec®), a computer-based algorithm versus standard (paper form-based) continuous insulin infusion (CII) in the treatment of patients with diabetic ketoacidosis (DKA) | ||
| 520 | |a METHODS: This was a retrospective multicenter study involving 2665 patients with DKA treated with either GM (n = 1750) or standard protocols (n = 915) across 34 institutions in the United States. GM estimates the rate of CII using an insulin sensitivity factor referred to as a "multiplier" that ranges between 0.01 and 0.03. Outcomes of interest were differences in time to resolve DKA (blood glucose [BG] <200 mg/dL and bicarbonate < 18 mmol/L) and number of hypoglycemic events defined as a BG <70 mg/dl | ||
| 520 | |a RESULTS: Treatment with GM was associated with lower rates of hypoglycemia during the time of the insulin drip (12.9% vs 35%, P = .001), faster time to normalization of blood glucose (9.7 ± 8.9 vs 10.97 ± 10.2 hours, P = .0001) and resolution of metabolic acidosis (13.6 ± 11.8 vs 17.3 ± 19.6 hours, P = .0001), and shorter hospital length of stay (3.2 ± 2.9 vs 4.5 ± 4.8 days, P = .01) compared to standard care. Best treatment outcomes were achieved with an initial multiplier of 0.01 and a glucose target range between 120 and 180 mg/dl | ||
| 520 | |a CONCLUSION: The GM algorithm in DKA treatment resulted in lower rates of hypoglycemia and faster DKA resolution over standard paper-based algorithms. Prospective randomized clinical trials comparing the efficacy and cost of computer-based algorithms versus standard CII regimens are warranted | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Glucommander | |
| 650 | 4 | |a diabetic ketoacidosis | |
| 650 | 4 | |a electronic glucose management system | |
| 650 | 4 | |a intravenous insulin | |
| 650 | 7 | |a Blood Glucose |2 NLM | |
| 650 | 7 | |a Hypoglycemic Agents |2 NLM | |
| 650 | 7 | |a Insulin |2 NLM | |
| 700 | 1 | |a Aloi, Joseph A |e verfasserin |4 aut | |
| 700 | 1 | |a Reyes-Umpierrez, David |e verfasserin |4 aut | |
| 700 | 1 | |a Pasquel, Francisco J |e verfasserin |4 aut | |
| 700 | 1 | |a McFarland, Raymie |e verfasserin |4 aut | |
| 700 | 1 | |a Rabinovich, Marina |e verfasserin |4 aut | |
| 700 | 1 | |a Umpierrez, Guillermo E |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of diabetes science and technology |d 2007 |g 12(2018), 1 vom: 02. Jan., Seite 39-46 |w (DE-627)NLM179163914 |x 1932-2968 |7 nnns |
| 773 | 1 | 8 | |g volume:12 |g year:2018 |g number:1 |g day:02 |g month:01 |g pages:39-46 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1177/1932296817750899 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 12 |j 2018 |e 1 |b 02 |c 01 |h 39-46 | ||