Evaluating the safety and efficacy of Glucommander, a computer-based insulin infusion method, in management of diabetic ketoacidosis in children, and comparing its clinical performance with manually titrated insulin infusion

Abstract

The Glucommander is a computer-based system for directing intravenous insulin infusion. Using a physician-selected glucose target range and a weight-based multiplier, it recommends an insulin infusion rate and interval to next glucose measurement. We evaluated the safety and efficacy of this system by conducting a retrospective chart review of 65 new-onset or existing type 1 diabetic children, admitted with diabetic ketoacidosis (DKA), managed with the Glucommander. We compared outcomes with 22 patients managed using manually titrated infusion. Time to glycemic control and correction of acidosis, number of insulin units used per kilogram per hour, and length of pediatric intensive care unit (PICU) and total hospital stay were analyzed using measures of central tendency. Children managed with Glucommander achieved equally rapid glycemic control and correction of acidosis, used less intravenous insulin, and spent less time in both PICU and hospital overall, compared to those managed with manual insulin infusion.