title: Use of a Computer-Based Insulin Infusion Algorithm to Treat Diabetic Ketoacidosis in the Emergency Department.
abstract: BACKGROUND
  Efforts at improving quality metrics in diabetes focus on minimizing adverse events and avoiding re-admissions to the hospital. Our experience with Glucommander™ (Glytec, Greenville, SC), a cloud-based insulin management software system, suggested that its use in the emergency department (ED) would be useful in treating patients with mild diabetic ketoacidosis (DKA).
  
  
  METHODS
  Thirty-five patients seen in the ED with hyperglycemic crises and diagnosed with DKA during one calendar year were reviewed. A retrospective chart review was performed on patients who were placed on Glucommander™ for DKA management. We excluded patients with significant acidosis or concomitant medical illnesses.
  
  
  RESULTS
  Initial average capillary glucose level was 487 ± 68 mg/dL, average time to target glucose was 5 h 11 min, and rate of hypoglycemia (blood glucose level <70 mg/dL) was less than 0.3%. Sixteen patients treated with the protocol were discharged from the ED directly, and 19 were admitted. Patients were maintained for an average of 14 ± 1 h on the Glucommander™ protocol. There was a significantly higher anion gap (P = 0.002) and lower serum bicarbonate level (P = 0.006) in the admitted group. We found very low evidence of re-admission (6%) within 30 days of discharge from the ED for DKA patients. No significant glucose-related adverse events were noted.
  
  
  CONCLUSIONS
  Use of Glucommander™ for guiding the insulin treatment of mild DKA in the ED can decrease admissions to the hospital for DKA by 45%. Low rates of hypoglycemia make this an option to improve efficiency of utilization of inpatient hospital beds. The cost savings for nonadmissions were estimated at $78,000 over the 12 months of the study. Our results suggest that Glucommander™ is a safe and efficient tool for use in the ED to manage mild to moderate DKA.
authors.affiliation: 1 EVMS Strelitz Diabetes Center and Division of Endocrinology and Metabolism, Department of Internal Medicine, Eastern Virginia Medical School , Norfolk, Virginia.
authors.forename: Jagdeesh
authors.initials: J
authors.lastname: Ullal
authors.affiliation: 2 Department of Quality Initiatives, Glytec , Greenville, South Carolina.
authors.forename: Raymie
authors.initials: R
authors.lastname: McFarland
authors.affiliation: 3 Diabetes Center, Sentara Virginia Beach General Hospital , Virginia Beach, Virginia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Bachand
authors.affiliation: 4 Department of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest School of Medicine , Winston-Salem, North Carolina.
authors.forename: Joseph
authors.initials: J
authors.lastname: Aloi
mesh_terms: D000328:Adult; D000465:Algorithms; D016883:Diabetic Ketoacidosis / Q000188:drug therapy*; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D012189:Retrospective Studies; D012984:Software; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin