Health systems are utilizing insulin dosing algorithms (IDA) within the EMR to adjust IV insulin (IVI). EndoTool IV (ETIV) is IDA software for blood glucose (BG) management which evaluates BG values to recommend IV insulin/dextrose doses to adjust the BG level within a target range. ETIV was integrated with our EMR as part of a quality project to reduce hypoglycemia in IVI patients. The tool was started in two of our ICUs that treat our DKA admissions. Dashboards capture BG values defined as hypoglycemia BG less than 70 mg/dL, severe hypoglycemia BG less than 40 mg/dL, and length of hospital stay for diabetic ketoacidosis (DKA LOS). Dosing modalities were available for hyperglycemia, HHS or DKA; 90% of ordering providers selected the hyperglycemia mode. We report results on the first 437 patient runs. The population was 60 % type 2 DM, 16 % type 1 and the remainder unknown. Average BG at IVI start was 221.5 mg/dL with an average time to goal of 4.7 hours. This translated to an average time on IVI of 15.5 hours for the group studied. Adoption of ETIV was associated with an approximate 5-fold reduction in hypoglycemic BG values, elimination of observed severe hypoglycemic BG values and a reduction in length of stay for DKA LOS. We conclude that ETIV is effective in reducing hypoglycemic events in persons treated with IVI and may reduce DKA LOS. Hospital systems considering a quality improvement project to reduce inpatient hypoglycemia for IVI should consider adopting an IDA.


J.Aloi: Research Support; Abbott Diabetes, Medtronic. C.E.Price: None. C.O.Usoh: None. K.Dunn: None.

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