Comparison of Computer-Guided Versus Standard Insulin Infusion Regimens in Patients With Diabetic Ketoacidosis

Ullal, Jagdeesh; Aloi, Joseph; Reyes-Umpierrez, David; Pasquel, Francisco J.; McFarland, R.; Rabinovich, Marina; Umpiérrez, Guillermo E.

doi:10.1177/1932296817750899

Cited by 39 publications

(27 citation statements)

References 21 publications

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“…Use of standardized paper based and computerized guidelines and protocols for management of diabetic ketoacidosis has been shown to decrease the time to anion gap closure, reduce length of stay in hospital, and minimize complications during treatment for diabetic ketoacidosis 5354555657. However, even when protocols are available and healthcare providers are aware of them, adherence is often poor 414258.…”

Section: Acute Managementmentioning

confidence: 99%

“…More commonly observed complications in adults include hypokalemia and hyperkalemia, hypoglycemia, and non-anion gap hyperchloremic metabolic acidosis 415667. Hypokalemia is reported more frequently than hyperkalemia and usually results from delays in administration of or insufficient potassium containing supplementation.…”

Section: Complications Related To Management Of Diabetic Ketoacidosismentioning

confidence: 99%

“…Hyperkalemia can result from overly aggressive potassium replacement, particularly in patients with underlying renal dysfunction 5567. Hypoglycemia can result from overly aggressive insulin infusions, insufficient frequency of blood glucose monitoring, or failure to add dextrose to intravenous fluids when blood glucose concentrations approach 13.9 mmol/L (250 mg/dL) 5556…”

Section: Complications Related To Management Of Diabetic Ketoacidosismentioning

confidence: 99%

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Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

French

Donihi

Korytkowski

2019

BMJ

135

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Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for preventing recurrence. It also discusses why many patients who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.

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Section: Acute Managementmentioning

confidence: 99%

Section: Complications Related To Management Of Diabetic Ketoacidosismentioning

confidence: 99%

Section: Complications Related To Management Of Diabetic Ketoacidosismentioning

confidence: 99%

See 1 more Smart Citation

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

French

Donihi

Korytkowski

2019

BMJ

135

View full text Add to dashboard Cite

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“…4. Ullal et al 9 Purpose: Ullal et al investigated the efficacy of Glucommander (Glytec) computer-based software versus a paper-based insulin infusion protocol in the treatment of patients with diabetic ketoacidosis (DKA).…”

Section: Why Use Computerized Glycemic Management Systems?mentioning

confidence: 99%

Evaluation of Several Electronic Glycemic Management Systems

Alamri

Seley

2018

J Diabetes Sci Technol

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Computerized insulin dosing software provides decision support in the form of pattern management identification, standardized dosing, and ease of use in both the inpatient and outpatient settings. The purpose of this analysis article is to review the features of all three electronic glycemic management systems available in the United States and to discuss the potential benefits of an automated insulin dosing system compared to a paper protocol or electronic order set. Four articles will be presented in this inpatient focused issue that examine the safety and efficacy of the Glytec® eGlycemic Management system in a variety of patient populations.

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“…In the United States, the national incidence of hypoglycaemia during DKA treatment is unknown, but a 35% incidence was recently described with standard care in a study of 34 centres. [13] American adherence to DKA guidelines is poor; efforts to implement American guidelines may overlook the rate-reduction step and even lead to increased hypoglycaemia. [14] It is thus feasible that a burden of avoidable hypoglycaemia exists in American hospitals as well.…”

Section: Introductionmentioning

confidence: 99%

Fixed-rate insulin for adult diabetic ketoacidosis is associated with more frequent hypoglycaemia than rate-reduction method: a retrospective cohort study

Lorenson

Cusumano

Stewart

et al. 2019

International Journal of Pharmacy Practice

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Objective To assess whether hypoglycaemia incidence during management of adult diabetic ketoacidosis (DKA) differed following transition from a fixed‐rate insulin protocol to a protocol using an empiric insulin rate reduction after normoglycaemia. Methods We retrospectively reviewed charts from adult patients managed with a DKA order set before and after order set revision. In cohort 1 (n = 77), insulin rate was 0.1 unit/kg/h with no adjustments and dextrose was infused at 12.5 g/h after glucose reached 250 mg/dl. In cohort 2 (n = 78), insulin was reduced to 0.05 unit/kg/h concurrent with dextrose initiation at 12.5 g/h after glucose reached 200 mg/dl. The primary outcome was hypoglycaemia (glucose < 70 mg/dl) within 24 h of the first order for insulin. Key findings The 24‐h incidence of hypoglycaemia was 19.2% in cohort 2 versus 32.5% in cohort 1; the adjusted odds ratio was 0.46 (95% confidence interval (CI) [0.21, 0.98]; P = 0.047). The 24‐h use of dextrose 50% in water (D50W) was also reduced in cohort 2. No differences were seen in anion gap or bicarbonate normalization, rebound hyperglycaemia or ICU length of stay. In most patients who became hypoglycaemic, the preceding glucose value was below 100 mg/dl. Conclusions The insulin rate‐reduction protocol was associated with less hypoglycaemia and no obvious disadvantage. Robust intervention for low‐normal glucose values could plausibly achieve low hypoglycaemia rates with either approach.

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Comparison of Computer-Guided Versus Standard Insulin Infusion Regimens in Patients With Diabetic Ketoacidosis

Abstract: The GM algorithm in DKA treatment resulted in lower rates of hypoglycemia and faster DKA resolution over standard paper-based algorithms. Prospective randomized clinical trials comparing the efficacy and cost of computer-based algorithms versus standard CII regimens are warranted.

Cited by 39 publications

References 21 publications

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

Evaluation of Several Electronic Glycemic Management Systems

Fixed-rate insulin for adult diabetic ketoacidosis is associated with more frequent hypoglycaemia than rate-reduction method: a retrospective cohort study

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