title: Software-guided insulin dosing: tight glycemic control and decreased glycemic derangements in critically ill patients.
abstract: OBJECTIVE
  To determine whether glycemic derangements are more effectively controlled using software-guided insulin dosing compared with paper-based protocols.
  
  
  METHODS
  We prospectively evaluated consecutive critically ill patients treated in a tertiary hospital surgical intensive care unit (ICU) between January 1 and June 30, 2008, and between January 1 and September 30, 2009. Paper-based protocol insulin dosing was evaluated as a baseline during the first period, followed by software-guided insulin dosing in the second period. We compared glycemic metrics related to hyperglycemia, hypoglycemia, and glycemic variability during the 2 periods.
  
  
  RESULTS
  We treated 110 patients by the paper-based protocol and 87 by the software-guided protocol during the before and after periods, respectively. The mean ICU admission blood glucose (BG) level was higher in patients receiving software-guided intensive insulin than for those receiving paper-based intensive insulin (181 vs 156 mg/dL; P=.003, mean of the per-patient mean). Patients treated with software-guided intensive insulin had lower mean BG levels (117 vs 135 mg/dL; P=.0008), sustained greater time in the desired BG target range (95-135 mg/dL; 68% vs 52%; P=.0001), had less frequent hypoglycemia (percentage of time BG level was <70 mg/dL: 0.51% vs 1.44%; P=.04), and showed decreased glycemic variability (BG level per-patient standard deviation from the mean: ±29 vs ±42 mg/dL; P=.01).
  
  
  CONCLUSIONS
  Surgical ICU patients whose intensive insulin infusions were managed using the software-guided program achieved tighter glycemic control and fewer glycemic derangements than those managed with the paper-based insulin dosing regimen.
authors.affiliation: Department of Surgery, Boston, MA, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Saur
authors.forename: Gail L
authors.initials: GL
authors.lastname: Kongable
authors.forename: Sharon
authors.initials: S
authors.lastname: Holewinski
authors.forename: Keri
authors.initials: K
authors.lastname: O'Brien
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Nasraway
mesh_terms: D018806:APACHE; D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D016638:Critical Illness / Q000628:therapy; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D005260:Female; D038321:Glycemic Index / Q000187:drug effects; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012984:Software
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: APACHE II; Acute Physiology and Chronic Health Evaluation II; BG; CV; GPI; GV; ICU; MAGE; blood glucose; coefficient of variation; glycemic penalty index; glycemic variability; intensive care unit; mean amplitude of glycemic excursions