Algorithm changes in Computerized IV Insulin Infusion Protocol Using the Clarian Glucostabilizer (CGS) result in marked reduction in incidence of Hypoglycemia.

Author Block: C. Roudebush¹, R. Juneja², A. Golas², J. Carroll¹, D. Nelson¹,
S. Flanders¹; ¹Medicine, Clarian Health Partners, Indianapolis, IN, United States, ²Medicine, Indiana University, Indianapolis, IN, United States.

Background and Aims:
We have previously shown the effectiveness of a computerized IV Insulin (IVI) protocol in achieving and maintaining Blood Glucose (BG) targets. Once the physician orders IV insulin with a target BG range, the IVI program recommends an insulin infusion rate followed by an alarm for BG checks every 60-120 minutes. Once a new BG is entered, the program recommends change/no change in the insulin infusion until target BG is reached.
 

Materials and Methods:
This study focused on cardiovascular surgery patients, whose target BGs generally are 80-110 mg/dl in our institution. With this protocol, average hypoglycemia rate (BG ≤ 70 mg/dl) was 4.25%, with 0.42% of BGs being <= 50 mg/dl. To attempt to further decrease hypoglycemia while on the protocol, we instituted the following changes in the algorithms used in the Clarian Glucostabilizer (CGS©) Protocol: If a patient had 3 out of the last 8 blood glucose values ≤ 70 mg/dl, the infusion rate was cut in half and the target blood glucose range was raised by 10 mg/dl at the lower and upper limits (e.g. target of 80-110 mg/dl was changed to 90-120 mg/dl). These changes were instituted in late Dec 2005 (data point 2005-52).

Results:
For % BG ≤ 70 mg/dl, with the above process modification, we were able to show a statistically significant 30% reduction in the hypoglycemia rate from 4.25% to 2.99% (see “p” Control Chart; %BGs <=70).

 

 

For % BG ≤ 50 mg/dl, the hypoglycemia rate was reduced by 43%, from 0.42% to 0.24%. There were some readings in week 2006-8, when there were a total of 8 events with BG ≤ 50 mg/dl, which skewed the statistical significance for this BG level, but overall the trend appears to be towards marked reduction in the hypoglycemia frequency (see “p” chart, %BGs <=50).

 

Conclusion:
Programming an algorithm change of a reduction in the infusion rate and slightly less aggressive BG targets in patients on IV insulin, results in a marked decrease in the frequency of hypoglycemia thus increasing the safety of the Clarian Glucostabilizer, a computerized IV insulin Protocol.