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Multicenter Comparison of Computerized Insulin Sensitivity Coefficient and Paper-Based Intravenous Insulin Protocols
Amy K Janowski1, Nandini Patel1, Lydia R Ware1
1Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
Journal of Diabetes Science and Technology
|July 15, 2026
Summary
A new computerized insulin infusion calculator using insulin sensitivity coefficient (ISC) improved glycemic control in critically ill patients. This protocol achieved more blood glucose values within the target range and reduced hypoglycemia compared to older paper-based methods.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Pharmacology
Background:
- Computerized intravenous (IV) insulin infusion calculators offer potential for safe and effective glycemic control.
- Historically, paper-based protocols were used, but a shift to a computerized insulin sensitivity coefficient (ISC)-based protocol occurred in 2024.
- This study aimed to evaluate the safety and efficacy of the new computerized ISC-based protocol against previous methods.
Purpose of the Study:
- To compare the safety and efficacy of a computerized ISC-based insulin infusion calculator with prior paper-based protocols.
- To assess the impact of the computerized protocol on achieving target blood glucose levels.
- To evaluate changes in hyperglycemia and hypoglycemia rates post-implementation.
Main Methods:
- A pre-post intervention analysis was conducted involving critically ill adult patients.
- Data were collected from March to May 2023 for paper-based protocols and November to December 2024 for the computerized ISC-based protocol.
- Primary outcome: percentage of blood glucose levels within the 80-180 mg/dL range. Secondary outcomes: rates of hyperglycemia and hypoglycemia.
Main Results:
- The computerized ISC-based protocol group (78.3% in range) showed a higher percentage of blood glucose values within the target range compared to the paper-based group (73%) (P < .01).
- Rates of hyperglycemia (12.6% vs 16.6%) and severe hyperglycemia (4.0% vs 5.7%) were significantly lower with the computerized protocol (P < .01).
- Hypoglycemia rates were also lower (0.2% vs 0.7%) with the computerized protocol (P < .01), with no significant difference in severe hypoglycemia.
Conclusions:
- The computerized insulin sensitivity coefficient (ISC)-based insulin infusion protocol demonstrates superior efficacy in achieving target glycemic control.
- This protocol leads to a significant reduction in hyperglycemia and hypoglycemia compared to traditional paper-based methods.
- The computerized ISC-based protocol represents a safer and more effective approach to managing insulin infusions in critically ill patients.
