Computerized insulin dosing tool succeeds in diabetic ketoacidosis treatment

Use of the computerized insulin dosing tool (CIDT) with 24-hour pharmacist monitoring is efficacious and safe for the treatment of diabetic ketoacidosis (DKA) as compared with a provider-driven insulin dosing strategy, suggests a study.

The investigators sought to determine the effects of CIDT on the treatment of a patient with DKA. They compared a provider-driven insulin dosing strategy (pregroup) with CIDT (postgroup) with 24-hour pharmacist monitoring in this retrospective, pre–post chart review.

The CIDT works by utilizing an equation that incorporates a patient’s most recent blood glucose value and recommends a rate of insulin (units/hour) every hour.

The two groups had similar baseline characteristics. No significant differences were noted in average time to anion gap closure (≤12 mEq/L) or intensive care unit (ICU) length of stay between the pregroup (12.5 vs 10.5 hours; p=0.235) and the postgroup (40.6 vs 40.8 hours; p=0.945).

In addition, 17 hypoglycaemic events (blood glucose <70 mg/dL) were reported in the pregroup with four being severe (blood glucose <50 mg/dL). In the postgroup, five hypoglycaemic events occurred, of which none were severe.

“CIDT ha[s] been shown to improve the care of critically ill patients with hyperglycaemia,” the investigators said.

An earlier study assessed the efficacy of a unified hyperglycaemia and DKA insulin infusion protocol (IIP), based on an Excel algorithm and implemented as an electronic order set, in achieving glycaemic targets and minimizing hypoglycaemia. Results showed that IIP maintained acceptable target range without hypoglycaemia for patients in the ICU setting without requiring complex nursing calculations. [Diabetes Metab Syndr 2017;11:265-271]