Evaluation of a standardized inpatient insulin therapy based on electronic insulin dose calculation - a before after cohort proof of concept study

Diabetes is a common comorbidity in hospitalized patients. The necessity of blood glucose control in those patients with low variability and avoidance of hypoglycemic episodes is well-known. Yet, there is still only marginal literature about the optimal therapy of hyperglycemia in non critically ill hospitalized patients using tools of modern electronic patients charts. The present study aimed to investigate the feasibility, the safety and efficiency of a standardized inpatient insulin therapy based on a new electronic insulin dose calculating program. In this retrospective study with a before-after design, we compared patients treated with the new electronic insulin protocol (study group) to a historical group treated with a traditional paper-based sliding scale insulin protocol (SSI). Patients were selected with the aid of the hospital's electronic medical system. Inclusion criteria for patients were either a lower respiratory tract infection or an acute cardiac condition with diabetes as a known comorbidity. Blood glucose levels were measured four times a day during the first 120 in-hospital hours. In the study group, all included patients were treated with the new electronic insulin protocol, which calculated an appropriate dose of short-acting insulin considering actual blood glucose, ingested carbohydrates and a defined resistance factor. Patients treated with the electronic insulin protocol were compared to a matched historical control group referring to the mean glucose levels, hypoglycemia and variability of blood glucose levels. While mean glucose levels were equal between the two groups (8.65 to 8.70), there was a trend towards less hypoglycemic episodes (1.26% to 1.46%, p = 0.120) and a significant smaller variability (6.36 to 8.75, p = 0.025) in patients treated with the electronic insulin protocol. In a real-life setting an electronic insulin protocol may improve and simplify glycemic control with less variability and a trend towards less hypoglycemic events among non-critically ill hospitalized patients.