No patient left behind: evaluation and design of intravenous insulin infusion algorithms.
OBJECTIVE
To define the characteristics of performance evaluation, algorithm design, and regulation of insulin delivery by which professionals and the healthcare system might differentiate between methodologies for intravenous insulin infusion.


METHODS
Published performance criteria used in the assessment of intravenous insulin infusion algorithms are classified. The structure of intravenous insulin infusion formulae is reviewed, as are technologies that might lead to future improvement.


RESULTS
Among published reports, no standardization was discernable for description of algorithm characteristics or performance. Except for time-to-target and hypoglycemic episodes, measures using the patient as unit of observation are not employed consistently.


CONCLUSIONS
The healthcare system needs criteria for evaluation and minimal acceptable standards for assessing performance of any algorithm, decision support system, or closed-loop system for intravenous insulin infusion. Inclusion of patient-based measures is necessary to assess the ability of an algorithm to control variability between patients and within a given run. Standardization of performance reporting will help users to select appropriate methodologies.
Braithwaite
Susan S
SS
University of North Carolina, Durham, North Carolina.
Godara
Hemant
H
Song
Hui-Jeong
HJ
Rock
Peter
P
D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007262:Infusions, Intravenous / Q000379:methods; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000592:standards*; D015203:Reproducibility of Results
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin