Jul 2026· Journal of Diabetes Science and Technology· pp.
19322968261462502
· 0 citations· 23 references
Medicine
TL;DR
A computerized ISC-based insulin infusion protocol resulted in more blood glucose values in target range and lower rates of hypoglycemia compared with paper-based protocols.
Abstract
INTRODUCTION
Computerized intravenous (IV) insulin infusion calculators may offer a safe and efficacious means of achieving glycemic control. Historically, our health system utilized various paper-based IV insulin infusion protocols but transitioned to a computerized insulin infusion calculator protocol based on the insulin sensitivity coefficient (ISC) in 2024. The objective of this study was to compare the safety and efficacy of the computerized ISC-based insulin infusion calculator protocol with previous protocols.
Methods
This was a pre-post intervention analysis of critically ill adult patients initiated on a paper-based insulin infusion across 13 institutions from March 2023 to May 2023 for pre-analysis and patients on a computerized, ISC-based insulin infusion from November 2024 to December 2024 for post-analysis. The primary outcome was the percentage of blood glucose levels within target range (80-180 mg/dL). Secondary outcomes included rates of hyperglycemia (>200 mg/dL), severe hyperglycemia (>250 mg/dL), hypoglycemia (<70 mg/dL), and severe hypoglycemia (<54 mg/dL).
Results
In total, 207 and 237 patients were included in the pre- and post-intervention groups, respectively. For the primary outcome, 4610 of 6313 (73%) and 6163 of 7870 (78.3%) of blood glucose values were in range in the pre- and post-intervention groups, respectively (P < .01). There was no difference in severe hypoglycemia (0.2% vs 0.1%, P = .24), but rates of hyperglycemia (16.6% vs 12.6%, P < .01), severe hyperglycemia (5.7% vs 4.0%, P < .01), and hypoglycemia (0.7% vs 0.2%, P < .01) were higher in the pre-intervention group.
Conclusions
A computerized ISC-based insulin infusion protocol resulted in more blood glucose values in target range and lower rates of hypoglycemia compared with paper-based protocols.
BACKGROUND
Automated insulin delivery (AID) systems are increasingly used by individuals living with diabetes in the outpatient setting, but data on their safety and effectiveness during hospitalizations remains limited. The objective is to evaluate the use and efficiency of AID systems in hospitalized adults with diabetes.
METHODS
We performed a retrospective cohort study based on electronic health record data from hospital admissions of 316 patients with diabetes using insulin pumps. Automated insulin delivery and continuous glucose monitor use, insulin pump continuation, length of stay (LOS), and glycemic outcomes among the cohort were analyzed. The primary aims of the study were to describe rates of insulin pump continuation and reasons associated with removal, and rates of pump reinitiation. Secondary outcomes included effects of insulin pump removal and prompt endocrinology consultation on inpatient glycemic outcomes and LOS.
RESULTS
Insulin pumps were continued in 64.2% of all admissions. The most common reason for pump discontinuation was surgery (30.1%). Length of stay was longer when pumps were removed (8.3 vs 4.7 days, P < .001) and when endocrinology consultation occurred more than 24 hours after admission (P < .001). Insulin pump continuation was associated with lower hyperglycemia (glucose >180 mg/dL) rates without an increase in hypoglycemia (glucose <70 mg/dL) in both critical and noncritical care settings.
CONCLUSIONS
Continuation of insulin pumps was associated with improvement in hyperglycemia without increased hypoglycemia risk and with shorter LOS in the hospital. Standardized institutional policies including prompt glycemic management team consultation may help expand safe continuation of AID during hospitalizations.
Kathleen R Ruddiman, J. Evans, Joseph A. Aloi et al.· Journal of Diabetes Science...· 0 citations
A practice-oriented evaluation of the indications, clinical benefits, and safety of modern diabetes technologies and suggests that technologies should be offered according to individual needs, abilities, preferences, and life circumstances and implemented early, including at the time of diagnosis.
OBJECTIVE
To report and analyze the long-term performance of Glucopilot, a clinical decision support system for intravenous (IV) insulin therapy.
METHODS
This retrospective cohort study included adult patients across 9 hospitals who received IV insulin guided by Glucopilot between August 18, 2020 and May 30, 2025. Admissions with fewer than 10 hours of IV insulin or insufficient glucose monitoring were excluded. Using point-of-care glucose data from the electronic health record, we evaluated time to euglycemia, time in glycemic ranges, and severe dysglycemic events, with subgroup analyses (eg, diabetes type, diabetic ketoacidosis, sepsis, and steroid use) and multivariable models to assess glycemic performance and factors associated with sustained euglycemia (ie, 100% time in euglycemia after initial attainment) and severe hyperglycemia (ie, ≥300 mg/dL).
RESULTS
There were 1239 admissions included. All patients presenting with hyperglycemia achieved euglycemia, with a median time to euglycemia of 174 minutes. Thereafter, median time in euglycemia was 96%, with 4% median time in hyperglycemia, and 0% median time in hypoglycemia. Sustained euglycemia was observed in 43.4% of admissions, and steroid use was not associated with reduced likelihood of achieving sustained euglycemia. Baseline glucose was strongly associated with time to euglycemia but not with subsequent time in euglycemia after attainment. Glycemic control was consistent across subgroups.
CONCLUSIONS
Use of Glucopilot, an electronic medical record-integrated adaptive insulin dosing software, was associated with timely attainment of euglycemia and sustained glycemic control with a median of 0% time in hypoglycemia in real-world practice.
Benjamin Lalani, Ruth Penno, Curt Bay et al.· Journal of Diabetes Science...· 0 citations
BACKGROUND
This study examined how automatic correction boluses (ABs) vary according to active insulin time (AIT) and glucose target settings, and how these parameters impact glycemic control in individuals with type 1 diabetes.
METHODS
Retrospective data from 287 individuals with type 1 diabetes using the MiniMed 780G system in auto-mode for at least 80% of the time over a minimum period of 6 months were analyzed. The AB delivery was evaluated in relation to different AIT and glucose target settings. Glycemic outcomes, including time in range (TIR 70-180 mg/dL), were assessed.
RESULTS
Automatic correction boluses accounted for 33.1% of bolus insulin and 18.3% of the total daily insulin dose (TDD). Active insulin time settings significantly influenced AB delivery: individuals using a 2-hour AIT showed higher percentages of ABs relative to both TDD and bolus insulin, as well as higher AB doses expressed in IU/kg/day. Shorter AIT settings were also associated with improved TIR. In contrast, glucose target settings ranging from 100 to 120 mg/dL did not significantly affect AB delivery or TIR.
CONCLUSION
Active insulin time is a key modifiable parameter influencing AB delivery and glycemic outcomes. Shorter AIT settings were associated with increased AB administration and improved TIR, whereas glucose target settings had no significant impact on these outcomes.
Giuseppe Papa, R. Cannarella, C. Gusmano et al.· Journal of Diabetes Science...· 0 citations
BACKGROUND
Treating young children with Type 1 diabetes (CwT1D) is challenging due to their very small need for insulin. We investigated the safety of diluted insulin (U10) in the AID system and how its use affected glycaemic outcomes compared to standard insulin.
METHODS
Patients aged 0-4 years who initiated treatment with diluted insulin in an AID system during the years 2020-2025 were identified from the diabetes registry (N = 19). They had a maximum daily insulin dose of ≤ 6 units. An age and gender-matched control group (N = 27) using standard insulin (U100) in an AID system was determined. Longitudinal CGM outcomes were analysed within the treatment group from the start of diluted insulin and between groups from diagnosis over 12 months to assess time-by-treatment effects.
RESULTS
After 3 months of diluted insulin use, TBR < 3.9 and TBR < 3.0 decreased significantly (from 4.6% ± 4.1% to 2.7% ± 2.5%, p = 0.008; from 1.2% ± 1.8% to 0.4% ± 0.6%, p = 0.01, respectively) and remained low through 12 months. Compared with controls, children using diluted insulin had lower TBR < 3.9 mmol/L at later follow-up visits. In the HbA1c-adjusted mixed-effects model, the between-group difference in change from 3 months was -1.85 percentage points at 9 months (95% CI: -3.26 to -0.44, p = 0.010) and -1.52 percentage points at 12 months (95% CI: -2.92 to -0.13, p = 0.032). No significant between-group changes in other CGM measures over time were observed.
CONCLUSION
The use of diluted insulin in young CwT1D, who require low insulin doses and use an automated insulin delivery system, reduces time below range with no evidence of increased hyperglycaemia.
Heidi Falk, Ada Aaltio, Mari-Anne Pulkkinen et al.· Diabetes, obesity and metabo...· 0 citations
Objectives Matching insulin injection timing with meals to optimize postprandial glucose excursions is a daily challenge for individuals with diabetes on a multiple daily injection (MDI) regimen. We aimed to analyze the impact of using a connected insulin pen cap (CIPC) on insulin injection timing and glycemic control. Research design and methods Pragmatic, real-life, multicenter, prospective, open-label, observational study, including one week of run-in and a 6-week follow-up, split into a two-week masked mode phase and a four-week active phase. Continuous glucose monitoring (CGM) and automatically tracked insulin injection data in individuals with insulin-treated diabetes (ITD) who started using the CIPC Insulclock. The baseline and five hours of paired CGM and rapid-acting insulin data collected from Insulclock v2.0® users were analyzed using the ROC detection methodology to identify meal events and the timing of insulin doses. Results Of 82 recruited patients, 52 completed the study (54.4 y, 56.6% women, 60.4% with type 1 diabetes [T1D]) across three hospitals and one primary care center in Spain. The CGM glucometrics comparison between the consecutive masked and active phases showed: Glucose Management Indicator (GMI) 8.1 + 1.7 vs 7.8 + 1.4% (-0.3%, p 0.034); Time in Range 70-180 (TIR): 56.9 + 24.5 vs 61.9 + 21.6% (+5.0%, p 0.0054); Time below range <70 (TBR70): 2.5 + 3.3 vs 1.76 + 2.6% (-0.74%, p 0.0015); Time above range >180 (TAR180): 40.9 + 25.3 vs 36.6 + 22.4% (-5.3%, p 0.016). The on-time insulin injections increased: 45.5 + 15.52 to 54.4 + 16.6% (p 0.0017). The timing of insulin injection relative to the post-meal glycemic excursions shifted from +5.6 min (IQR –19.8 to +34.0) in the masked phase (n = 231 events) to –5.9 min (IQR –27.6 to +33.9) in the active phase (n = 467 events) (p = 0.023). An earlier injection was associated with a reduction in TAR180 (p = 0.042). Questionnaires measuring patients’ reported outcomes (PROs) indicated a reduction in perceived treatment burden with the use of the Insulclock v2.0® CIPC. Conclusions The use of Insulclock v2.0® connected insulin pen cap is associated with improved insulin injection timing and glucometrics.
F. Gómez-Peralta, J. M. Borrachero, Estefanía Santos et al.· Frontiers in Endocrinology· 0 citations