Multicenter Comparison of Computerized Insulin Sensitivity Coefficient and Paper-Based Intravenous Insulin Protocols

Computerized intravenous (IV) insulin infusion calculators may offer a safe and efficacious means of achieving glycemic control. Historically, our health system utilized various paper-based IV insulin infusion protocols but transitioned to a computerized insulin infusion calculator protocol based on the insulin sensitivity coefficient (ISC) in 2024. The objective of this study was to compare the safety and efficacy of the computerized ISC-based insulin infusion calculator protocol with previous protocols.

This was a pre-post intervention analysis of critically ill adult patients initiated on a paper-based insulin infusion across 13 institutions from March 2023 to May 2023 for pre-analysis and patients on a computerized, ISC-based insulin infusion from November 2024 to December 2024 for post-analysis. The primary outcome was the percentage of blood glucose levels within target range (80-180 mg/dL). Secondary outcomes included rates of hyperglycemia (>200 mg/dL), severe hyperglycemia (>250 mg/dL), hypoglycemia (<70 mg/dL), and severe hypoglycemia (<54 mg/dL).

In total, 207 and 237 patients were included in the pre- and post-intervention groups, respectively. For the primary outcome, 4610 of 6313 (73%) and 6163 of 7870 (78.3%) of blood glucose values were in range in the pre- and post-intervention groups, respectively (P < .01). There was no difference in severe hypoglycemia (0.2% vs 0.1%, P = .24), but rates of hyperglycemia (16.6% vs 12.6%, P < .01), severe hyperglycemia (5.7% vs 4.0%, P < .01), and hypoglycemia (0.7% vs 0.2%, P < .01) were higher in the pre-intervention group.

A computerized ISC-based insulin infusion protocol resulted in more blood glucose values in target range and lower rates of hypoglycemia compared with paper-based protocols.