Computer Decision Support to Achieve Glycemic Control in the ICU
| Status: | Completed |
|---|---|
| Conditions: | Other Indications, Endocrine |
| Therapuetic Areas: | Endocrinology, Other |
| Healthy: | No |
| Age Range: | 18 - 80 |
| Updated: | 4/21/2016 |
| Start Date: | January 2008 |
| End Date: | January 2011 |
This study is intended to fill the knowledge gap regarding the burn population with research
that achieves scientific merit. we will determine the effectiveness of the computer decision
support system (CDSS) to facilitate glucose management in the critically ill burn patient.
The EndoTool™ computer decision support system will achieve glycemic control (defined as
80-110 mg/dL) in a shorter time, reduce glycemic excursion outside of target range, and
reduce incidence of hypoglycemia (blood glucose less than 50 mg/dL) in the critically ill
burn patient compared to the standard of care USAISR insulin titration protocol (Appendix
A).
that achieves scientific merit. we will determine the effectiveness of the computer decision
support system (CDSS) to facilitate glucose management in the critically ill burn patient.
The EndoTool™ computer decision support system will achieve glycemic control (defined as
80-110 mg/dL) in a shorter time, reduce glycemic excursion outside of target range, and
reduce incidence of hypoglycemia (blood glucose less than 50 mg/dL) in the critically ill
burn patient compared to the standard of care USAISR insulin titration protocol (Appendix
A).
This is a prospective, paired, randomized, cross-over design, with two groups: current
standard of care using the USAISR Burn Center insulin titration nomogram (Appendix A) and
insulin management using EndoTool™ (MD Scientific, LLC) decision support software. Patients
will thus serve as their own controls.
Upon admission to the burn ICU, patients expected to require continuous insulin infusion for
a minimum of 7 days will be placed on EndoTool™ CDSS for the first 24 hours of glycemic
management. At the 24 hour mark the patients will be randomly assigned to either the CDSS or
standard of care group in pairs. Thus, the first subject will be randomized to a group and
the second subject will be placed in the alternate group. This method will ensure equal
numbers of patients are enrolled in each group to eliminate bias of timing of intervention
due to the effect of increasing insulin resistance over time demonstrated in the burn
population (Pidcoke, unpublished, USAISR).
standard of care using the USAISR Burn Center insulin titration nomogram (Appendix A) and
insulin management using EndoTool™ (MD Scientific, LLC) decision support software. Patients
will thus serve as their own controls.
Upon admission to the burn ICU, patients expected to require continuous insulin infusion for
a minimum of 7 days will be placed on EndoTool™ CDSS for the first 24 hours of glycemic
management. At the 24 hour mark the patients will be randomly assigned to either the CDSS or
standard of care group in pairs. Thus, the first subject will be randomized to a group and
the second subject will be placed in the alternate group. This method will ensure equal
numbers of patients are enrolled in each group to eliminate bias of timing of intervention
due to the effect of increasing insulin resistance over time demonstrated in the burn
population (Pidcoke, unpublished, USAISR).
Inclusion Criteria:
- 18 years or older
- military or civilian burns on continuous insulin infusion for 7 days
Exclusion Criteria:
- not expected to receive insulin for 7 days
- less than 18 years old
- enrolled in the Continuous Glucose monitoring Study
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