Document Type


Degree Name



Dept. of Public Health & Preventive Medicine.


Oregon Health & Science University


Introduction: The purpose of this study was to compare a computer-based insulin protocol against two paper-based protocols to control hyperglycemia in intensive care unit (ICU) patients. A safe and effective protocol must minimize hyperglycemia and glucose variability while also avoiding hypoglycemia, all of which are associated with increased risk of death. In theory, computer-based protocols that base insulin dosing on the individual patient’s record of response offer better performance by adjusting to each patient’s sensitivity to insulin. Methods: This is a retrospective cohort study on 1896 patients admitted to four ICUs (surgical, medical/cardiac, trauma, and neuroscience) at an academic tertiary care hospital. We included all adult patients from January 2012 to October 2013 on one of three continuous insulin protocols for at least eight hours. The two paper-based protocols (Cardiothoracic Surgery (CTS) and Adult ICU) had a target glucose of 140-180 mg/dL. The computer-based insulin protocol (EndoTool) targeted a glucose of 150 mg/dL. All cardiothoracic surgery patients were automatically started on the CTS or EndoTool protocol, regardless of whether they had developed hyperglycemia; whereas all the other patients were started on either the Adult ICU or EndoTool protocol after developing hyperglycemia of 180 mg/dL or greater. In our analyses, the primary exposure was the type of insulin protocol (computer- vs. paper-based), and the primary outcome was performance in maintaining glucose control. Results: Among cardiothoracic surgery patients who were automatically placed on an insulin protocol without necessarily developing hyperglycemia, the mean glucose in the EndoTool group (130.9 mg/dL) was lower than the CTS group (138.8 mg/dL) (p




School of Medicine



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