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Cited by 21Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchPatient Safety and Medication Errors

Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and titration algorithm in the inpatient setting

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Sinha Gregory, Naina, Seley, Jane Jeffrie, Gerber, Linda M., Tang, Chin, Brillon, David·2016·Hospital Practice
DOI 10.1080/21548331.2016.1250603PMC PMC5605296
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Abstract

OBJECTIVES: More than one-third of hospitalized patients have hyperglycemia. Despite evidence that improving glycemic control leads to better outcomes, achieving recognized targets remains a challenge. The objective of this study was to evaluate the implementation of a computerized insulin order set and titration algorithm on rates of hypoglycemia and overall inpatient glycemic control. METHODS: A prospective observational study evaluating the impact of a glycemic order set and titration algorithm in an academic medical center in non-critical care medical and surgical inpatients. The initial intervention was hospital-wide implementation of a comprehensive insulin order set. The secondary intervention was initiation of an insulin titration algorithm in two pilot medicine inpatient units. Point of care testing blood glucose reports were analyzed. These reports included rates of hypoglycemia (BG < 70 mg/dL) and hyperglycemia (BG >200 mg/dL in phase 1, BG > 180 mg/dL in phase 2). RESULTS: In the first phase of the study, implementation of the insulin order set was associated with decreased rates of hypoglycemia (1.92% vs 1.61%; p < 0.001) and increased rates of hyperglycemia (24.02% vs 27.27%; p < 0.001) from 2010 to 2011. In the second phase, addition of a titration algorithm was associated with decreased rates of hypoglycemia (2.57% vs 1.82%; p = 0.039) and increased rates of hyperglycemia (31.76% vs 41.33%; p < 0.001) from 2012 to 2013. CONCLUSIONS: A comprehensive computerized insulin order set and titration algorithm significantly decreased rates of hypoglycemia. This significant reduction in hypoglycemia was associated with increased rates of hyperglycemia. Hardwiring the algorithm into the electronic medical record may foster adoption.

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  • Compared with baseline, studies found that hypoglycemic events decreased by 56-80%.

    “Compared with baseline, studies found that hypoglycemic events decreased by 56-80% (100,107,108).”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [100]

    The Results section reports that hypoglycemia rates decreased in both study phases, supporting the direction of the claim. But the reported changes—from 1.92% to 1.61% and from 2.57% to 1.82%—are relative decreases of about 16% and 29%, not 56–80%. (LLM, conf=0.90)

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Research works printed but not linked: 17

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Cited by

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Authors
Sinha Gregory, N., Seley, J. J., Gerber, L. M., Tang, C., & Brillon, D.
Affiliations
  • Joan and Sanford I Weill Medical College of Cornell University, Endocrinology, New York, NY, USA
  • Cornell University (US)
ORCID
Venue
Hospital Practice
Publisher
Informa UK Limited
Published
2016-10-19
Volume
44
Issue
5
Pages
260-265
ISSN
  • 0018-5809 (ISSN-L)
  • 2154-8331
  • 2377-1003
DOI
10.1080/21548331.2016.1250603
PMC
PMC5605296
OpenAlex
W2535656725
Cited by
21
References
2
Citations by year
2025: 4 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 6
FWCI
2.68
Type
journal article
Language
en
Open access
Locations
  • Hospital Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Center for Advancing Translational Science (UL1TR000457)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
hypoglycemia, hyperglycemia, decision support system, glycemic control, hospitalized patients, electronic health records
MeSH terms
Academic Medical Centers, Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diet, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Inpatients, Insulin, Male, Middle Aged, Patient Education as Topic, Pilot Projects, Prospective Studies, Therapy, Computer-Assisted, Young Adult, Patient Care Bundles

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