Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Mader, JK; Neubauer, KM; Schaupp, L; Augustin, T; Beck, P; Spat, S; Höll, B; Treiber, GM; Fruhwald, FM; Pieber, TR; Plank, J.
Efficacy, usability and sequence of operations of a workflow-integrated algorithm for basal-bolus insulin therapy in hospitalized type 2 diabetes patients.
Diabetes Obes Metab. 2014; 16(2):137-146
Doi: 10.1111/dom.12186
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- Führende Autor*innen der Med Uni Graz
- Lichtenegger Katharina
- Mader Julia
- Co-Autor*innen der Med Uni Graz
- Fruhwald Friedrich
- Höll Bernhard
- Pieber Thomas
- Schaupp Lukas
- Treiber Gerlies
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- Abstract:
- To evaluate glycaemic control and usability of a workflow-integrated algorithm for basal-bolus insulin therapy in a proof-of-concept study to develop a decision support system in hospitalized patients with type 2 diabetes. In this ward-controlled study, 74 type 2 diabetes patients (24 female, age 68 ± 11 years, HbA1c 8.7 ± 2.4% and body mass index 30 ± 7) were assigned to either algorithm-based treatment with a basal-bolus insulin therapy or to standard glycaemic management. Algorithm performance was assessed by continuous glucose monitoring and staff's adherence to algorithm-calculated insulin dose. Average blood glucose levels (mmol/l) in the algorithm group were significantly reduced from 11.3 ± 3.6 (baseline) to 8.2 ± 1.8 (last 24 h) over a period of 7.5 ± 4.6 days (p < 0.001). The algorithm group had a significantly higher percentage of glucose levels in the ranges from 5.6 to 7.8 mmol/l (target range) and 3.9 to 10.0 mmol/l compared with the standard group (33 vs. 23% and 73 vs. 53%, both p < 0.001). Physicians' adherence to the algorithm-calculated total daily insulin dose was 95% and nurses' adherence to inject the algorithm-calculated basal and bolus insulin doses was high (98 and 93%, respectively). In the algorithm group, significantly more glucose values <3.9 mmol/l were detected in the afternoon relative to other times (p < 0.05), a finding mainly related to pronounced morning glucose excursions and requirements for corrective bolus insulin at lunch. The workflow-integrated algorithm for basal-bolus therapy was effective in establishing glycaemic control and was well accepted by medical staff. Our findings support the implementation of the algorithm in an electronic decision support system. © 2013 John Wiley & Sons Ltd.
- Find related publications in this database (using NLM MeSH Indexing)
- Aged -
- Aged, 80 and over -
- Algorithms -
- Blood Glucose - drug effects
- Blood Glucose - metabolism
- Blood Glucose Self-Monitoring -
- Body Mass Index -
- Decision Support Techniques -
- Diabetes Mellitus, Type 2 - blood
- Diabetes Mellitus, Type 2 - drug therapy
- Dose-Response Relationship, Drug -
- Female -
- Glycated Hemoglobin A - drug effects
- Glycated Hemoglobin A - metabolism
- Humans -
- Hypoglycemic Agents - administration & dosage
- Inpatients -
- Insulin, Long-Acting - administration & dosage
- Male -
- Middle Aged -
- Monitoring, Physiologic -
- Patient Participation -
- Reproducibility of Results -
- Retrospective Studies -
- Treatment Outcome -
- Workflow -
- Find related publications in this database (Keywords)
- glycaemic control
- insulin analogues
- insulin therapy
- type 2 diabetes