ArticleCritical care (London, England)2009
Computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose measurement is performed frequently and on time.
Article in Critical care (London, England), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 84 citations in OpenAlex.
- American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022Guideline
- Computer decision support software safely improves glycemic control in the burn intensive care unit: a randomized controlled clinical study.Journal of burn care & research : official publication of the American Burn AssociationTrial
- Inpatient Insulin Dosing Calculators.Diabetes spectrum : a publication of the American Diabetes Association · 2025Article
- Nursing Perspectives on the Use of Continuous Glucose Monitoring in the Intensive Care Unit.Journal of diabetes science and technology · 2023Article
- Expert consensus on the glycemic management of critically ill patients.Journal of intensive medicine · 2022Article
- Glycemic targets in critically ill adults: A mini-review.World journal of diabetes · 2021Review
- Incorporating real-world evidence into the development of patient blood glucose prediction algorithms for the ICU.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Association Between Achieving Inpatient Glycemic Control and Clinical Outcomes in Hospitalized Patients With COVID-19: A Multicenter, Retrospective Hospital-Based Analysis.Diabetes care · 2021Article
- Maintaining Blood Glucose Levels in Range (70-150 mg/dL) is Difficult in COVID-19 Compared to Non-COVID-19 ICU Patients-A Retrospective Analysis.Journal of clinical medicine · 2020Article
- Review of Intravenous and Subcutaneous Electronic Glucose Management Systems for Inpatient Glycemic Control.Current diabetes reports · 2020Review
- Diabetes Technology in the Inpatient Setting for Management of Hyperglycemia.Endocrinology and metabolism clinics of North America · 2020Review
- An Electronic Health Record-Integrated Computerized Intravenous Insulin Infusion Protocol: Clinical Outcomes andDiabetes & metabolism journal · 2020Article
- Article
- Hypoglycemia Prevention by Algorithm Design During Intravenous Insulin Infusion.Current diabetes reports · 2018Review
- Evaluating the Implementation of the EndoTool Glycemic Control Software System.Diabetes spectrum : a publication of the American Diabetes Association · 2018Article
- Article
- The Clinical Benefits and Accuracy of Continuous Glucose Monitoring Systems in Critically Ill Patients-A Systematic Scoping Review.Sensors (Basel, Switzerland) · 2017Article
- Comparison of an Electronic Glycemic Management System Versus Provider-Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting.Journal of diabetes science and technology · 2017Observational
- Glucose management in the intensive care unit: are we looking for the right sweet spot?Annals of translational medicine · 2016Article
- Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol.Journal of clinical monitoring and computing · 2016Article
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Authors and funding
9 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionControl of blood glucose (BG) in critically ill patients is considered important, but is difficult to achieve, and often associated with increased risk of hypoglycemia. We examined the use of a computerized insulin dosing algorithm to manage hyperglycemia with particular attention to frequency and conditions surrounding hypoglycemic events.
methodsThis is a retrospective analysis of adult patients with hyperglycemia receiving intravenous (IV) insulin therapy from March 2006 to December 2007 in the intensive care units of 2 tertiary care teaching hospitals. Patients placed on a glycemic control protocol using the Clarian GlucoStabilizer IV insulin dosing calculator with a target range of 4.4-6.1 mmol/L were analyzed. Metrics included time to target, time in target, mean blood glucose +/- standard deviation, % measures in hypoglycemic ranges <3.9 mmol/L, per-patient hypoglycemia, and BG testing interval.
results4,588 ICU patients were treated with the GlucoStabilizer to a BG target range of 4.4-6.1 mmol/L. We observed 254 severe hypoglycemia episodes (BG <2.2 mmol/L) in 195 patients, representing 0.1% of all measurements, and in 4.25% of patients or 0.6 episodes per 1000 hours on insulin infusion. The most common contributing cause for hypoglycemia was measurement delay (n = 170, 66.9%). The median (interquartile range) time to achieve the target range was 5.9 (3.8 - 8.9) hours. Nearly all (97.5%) of patients achieved target and remained in target 73.4% of the time. The mean BG (+/- SD) after achieving target was 5.4 (+/- 0.52) mmol/L. Targeted blood glucose levels were achieved at similar rates with low incidence of severe hypoglycemia in patients with and without diabetes, sepsis, renal, and cardiovascular disease.
conclusionsGlycemic control to a lower glucose target range can be achieved using a computerized insulin dosing protocol. With particular attention to timely measurement and adjustment of insulin doses the risk of hypoglycemia experienced can be minimized.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.