|
KMID : 1200020200440010056
|
|
Diabetes & Metabolism Journal
2020 Volume.44 No. 1 p.56 ~ p.66
|
|
|
An Electronic Health Record-Integrated Computerized Intravenous Insulin Infusion Protocol: Clinical Outcomes and in Silico Adjustment
|
|
Park Sung-Woon
Lee Seung-Hyun
Cha Won-Chul
Hur Kyu-Yeon
Kim Jae-Hyeon
Lee Moon-Kyu
Park Sung-Min
Jin Sang-Man
|
|
|
Abstract
|
|
|
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 (n=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 in silico 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 (P=0.003), earlier (P=0.002), and more stable (P=0.017) achievement of a glucose range of 70 to 180 mg/dL. Initial glucose level (P=0.001), change in glucose during the first 2 hours (P=0.026), and change in insulin infusion rate during the first 3 hours (P=0.029) were independently associated with delayed responses. Increasing the insulin infusion rate temporarily according to these parameters in silico significantly reduced delayed responses (P<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.
|
|
|
KEYWORD
|
|
|
Computer simulation, Electronic health records, Insulin, Medical records systems, computerized
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
   
|