Utilization of a computerized intravenous insulin infusion program to control blood glucose in the intensive care unit.
BACKGROUND
This proof of concept study was designed to evaluate the safety and effectiveness of an intravenous insulin dosing calculator, the Clarian GlucoStabilizer program, and to determine the feasibility of its use as part of a glycemic control program. This paper discusses the impact of the GlucoStabilizer program on the glycemic control of intensive care patients with hyperglycemia.


METHODS
Patients admitted to the intensive care unit (ICU), requiring intravenous insulin, were treated using the GlucoStabilizer program. This program calculates an insulin drip rate based on the low and high blood glucose (BG) levels of the desired target range, the patient's current and previous BG levels, and an insulin sensitivity factor, with a goal of safely and expeditiously achieving and maintaining the patient's BG in the target range.


RESULTS
From October 2004 through March 2006, the GlucoStabilizer program has been used to treat 2,398 patients in the ICUs, with 177,279 BG measurements in its database. In these patients, 61.0% of BGs have been in the target range of 80-110 mg/dL, while 90.9% have been in the wider range of 60-150 mg/dL. The average BG was 106.5 mg/dL (SD 39.1 mg/dL), and the frequency of hypoglycemia (BG <50 mg/dL) was 0.4%. These results compare favorably with the level of glycemic control in the 3 months before implementation of the GlucoStabilizer program.


CONCLUSIONS
Use of the GlucoStabilizer program in the ICU resulted in improved glycemic control compared to the previous manually calculated glycemic control protocols.
Juneja
Rattan
R
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. rajuneja@iupui.edu
Roudebush
Corbin
C
Kumar
Nilay
N
Macy
Angela
A
Golas
Adam
A
Wall
Donna
D
Wolverton
Cheryl
C
Nelson
Deborah
D
Carroll
Joni
J
Flanders
Samuel J
SJ
D001786:Blood Glucose / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007196:Indiana; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods*
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin