title: Efficacy, usability and sequence of operations of a workflow-integrated algorithm for basal-bolus insulin therapy in hospitalized type 2 diabetes patients.
abstract: OBJECTIVE
  To evaluate glycaemic control and usability of a workflow-integrated algorithm for basal-bolus insulin therapy in a proof-of-concept study to develop a decision support system in hospitalized patients with type 2 diabetes.
  
  
  METHODS
  In this ward-controlled study, 74 type 2 diabetes patients (24 female, age 68 ± 11 years, HbA1c 8.7 ± 2.4% and body mass index 30 ± 7) were assigned to either algorithm-based treatment with a basal-bolus insulin therapy or to standard glycaemic management. Algorithm performance was assessed by continuous glucose monitoring and staff's adherence to algorithm-calculated insulin dose.
  
  
  RESULTS
  Average blood glucose levels (mmol/l) in the algorithm group were significantly reduced from 11.3 ± 3.6 (baseline) to 8.2 ± 1.8 (last 24 h) over a period of 7.5 ± 4.6 days (p < 0.001). The algorithm group had a significantly higher percentage of glucose levels in the ranges from 5.6 to 7.8 mmol/l (target range) and 3.9 to 10.0 mmol/l compared with the standard group (33 vs. 23% and 73 vs. 53%, both p < 0.001). Physicians' adherence to the algorithm-calculated total daily insulin dose was 95% and nurses' adherence to inject the algorithm-calculated basal and bolus insulin doses was high (98 and 93%, respectively). In the algorithm group, significantly more glucose values <3.9 mmol/l were detected in the afternoon relative to other times (p < 0.05), a finding mainly related to pronounced morning glucose excursions and requirements for corrective bolus insulin at lunch.
  
  
  CONCLUSIONS
  The workflow-integrated algorithm for basal-bolus therapy was effective in establishing glycaemic control and was well accepted by medical staff. Our findings support the implementation of the algorithm in an electronic decision support system.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: J K
authors.initials: JK
authors.lastname: Mader
authors.forename: K M
authors.initials: KM
authors.lastname: Neubauer
authors.forename: L
authors.initials: L
authors.lastname: Schaupp
authors.forename: T
authors.initials: T
authors.lastname: Augustin
authors.forename: P
authors.initials: P
authors.lastname: Beck
authors.forename: S
authors.initials: S
authors.lastname: Spat
authors.forename: B
authors.initials: B
authors.lastname: Höll
authors.forename: G M
authors.initials: GM
authors.lastname: Treiber
authors.forename: F M
authors.initials: FM
authors.lastname: Fruhwald
authors.forename: T R
authors.initials: TR
authors.lastname: Pieber
authors.forename: J
authors.initials: J
authors.lastname: Plank
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D015992:Body Mass Index; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007297:Inpatients; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010358:Patient Participation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D057188:Workflow
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human
keywords: glycaemic control; insulin analogues; insulin therapy; type 2 diabetes