Evaluation of compliance to an intravenous insulin infusion protocol in the management of diabetic ketoacidosis

Introduction: The American Diabetes Association Consensus Guidelines stress the importance of fluid management, electrolyte replacement and insulin therapy for the management of diabetic ketoacidosis (DKA). In September 2012, our institution implemented a paper-based, fixed-dose insulin infusion protocol targeting a blood glucose (BG) range of 140-180mg/dL for the management of hyperglycemia including DKA. This protocol is permitted for use on regular medical/surgical floors and intensive care units. To our knowledge, evaluation of compliance to a paper-based, fixed-dose insulin infusion protocol has not been evaluated, and few studies assessing compliance to other types of protocols exist. Objectives: To assess compliance with a paper-based, fixed-dose IV insulin infusion protocol, and evaluate its impact on safety and efficacy outcomes. Study Design: Single-center retrospective chart review of DKA patients admitted between January and December 2013. Methods: Patients 18 years or older, admitted through the emergency center, with a diagnosis of DKA and treated with the intravenous insulin infusion protocol were included. Compliance to the protocol was defined as correct adjustment of insulin infusion rate and correct timing of BG checks (plus or minus 20 minutes from the protocol-stated timeframe). Protocol efficacy was assessed with average BG during infusion, time to target BG, and percentage of BG values within the desired range. Safety outcomes were evaluated on incidence of hypoglycemia (BG <70mg/dL), hyperglycemia (BG >180mg/dL), and hypokalemia (K+ <3.3mEq/L). Descriptive statistics will be utilized to analyze data. Results: Data was collected on 72 patients. 46 had type 1 diabetes, and a majority (45.8%) were located in a progressive unit during their IV insulin infusion. To date, BG and IV insulin infusion data has been gathered encompassing a total of 1754 BG values. Compliance data analysis and its relation to safety and efficacy is ongoing and will be completed prior to March 1st, 2016. Conclusions: [Ongoing]