24-OR: Electronic Decision Support for Insulin Therapy Is Safe and Efficient in Inpatients with Type 2 Diabetes

Abstract

Attainment of good glycemic control in hospitalized patients with type 2 diabetes (T2D) is often hampered by fear of hypoglycemia and insufficient knowledge in insulin therapy. An electronic algorithm-based decision support system (GlucoTab®, decide Clinical Software GmbH, Graz, Austria) for inpatient management was developed and has proven efficacy in clinical trials. After implementing GlucoTab® in routine care, a retrospective analysis of T2D patients requiring subcutaneous insulin therapy on an Endocrinology ward was performed. Data from days when patients received algorithm-steered basal-bolus insulin therapy (BBI) was compared with days when insulin therapy was performed according to local standard care (SC) provided by an endocrinologist. As the treating physician was free to start/stop decision support during inpatient stay, patients switched between BBI and SC. During the first six months following GlucoTab® implementation, a total of 71 T2D patients required subcutaneous insulin therapy and subsequently were included in this analysis. Incomplete treatment days (e.g., admission and discharge days; days, where both therapy schemes applied) were excluded, resulting in 261 BBI and 274 SC days. Baseline characteristics were as follows: 39 % women, 99 % Caucasian, age 73.5 ± 12.5 years, diabetes duration 15.4 ± 10.6 years, HbA1c 70.4 ± 24.2 mmol/mol, BMI 29.0 ± 5.5 kg/m² and creatinine 1.6 ± 1.2 mg/dL. Mean daily glucose was lower for BBI vs. SC: 156.9 ± 35.7 mg/dL vs. 172.1 ± 47.3 mg/dL. Total daily insulin dose was higher for BBI vs. SC: 42.2 ± 25.2 U vs. 33.7 ± 20.9 U. Blood glucose (BG) in target (70-180 mg/dL) was higher for BBI vs. SC: 70 % vs. 61.2 %. BG <70 mg/dL was 1.6 % vs. 1.9 % and BG <54 mg/dL was 0.2 % vs. 0.6 % (BBI vs. SC, respectively). Continuous use of BBI resulted in a BG decline from 182 (day 1) to 147 mg/dL (day 10) while it remained elevated in SC (188 to 177 mg/dL). BBI showed beneficial glycemic control compared to SC in routine use during inpatient diabetes management. Disclosure D.A. Hochfellner: None. H. Ziko: None. M.H. Sagmeister: None. H. Elsayed: None. M. Cigler: None. T. Poettler: None. F. Aberer: None. G. Sendlhofer: None. P. Beck: Employee; Self; decide Clinical Software. Stock/Shareholder; Self; decide Clinical Software. J.K. Mader: Advisory Panel; Self; Becton, Dickinson and Company, Eli Lilly and Company, Medtronic, Prediktor Medical, Sanofi-Aventis. Speaker’s Bureau; Self; Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis.