Meghin Moynihan, PharmD
University of North Carolina Hospitals
Chapel Hill, North Carolina
Disclosure information not submitted.
Brandon Powell
University of North Carolina Hospitals
Chapel Hill, North Carolina
Disclosure information not submitted.
Ginger Barrick, PharmD, MSCR, BCPS
Pharmacist
University of North Carolina REX Hospital, United States
Disclosure information not submitted.
Kalynn Northam, PharmD, CPP, BCCCP
Pharmacist
University of North Carolina Medical Center, United States
Disclosure information not submitted.
Title: Safety of EndoTool Versus Fixed Dose Insulin Infusions for DKA or HHS in the Emergency Department
Introduction: EndoTool is a glucose management software system used for titrating insulin infusions. Literature evaluating the safety of EndoTool for management of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic syndrome (HHS) in the emergency department (ED) are lacking. Within our health system, University of North Carolina (UNC) REX Hospital ED utilizes EndoTool to titrate insulin infusions, while UNC Medical Center utilizes fixed dosing (0.1 units/kg/hr). The goal of this project was to evaluate the safety between these practices in DKA and HHS patients. We hypothesized EndoTool would be safer than fixed dosing.
Methods: This retrospective evaluation included adults who presented to UNC REX Hospital or UNC Medical Center ED between 1/1/2019 and 12/31/2019 with DKA or HHS and received an insulin infusion. All included patients at UNC REX Hospital received insulin infusions titrated using EndoTool, while all patients at UNC Medical Center received fixed dosing. Outcomes compared included mean blood glucose values, mean insulin infusion rates, and incidence of hypoglycemic events (blood glucose < 70 mg/dL). All outcomes were evaluated while patients were in the ED.
Results: Two hundred twenty-three patients were included (n = 117 EndoTool, n = 106 fixed dosing) and the majority presented with DKA (n = 199). Initial point-of-care (POC) blood glucose (583.2 ± 124.7 vs 480.9 ± 133.4, p = 0.893) and average POC blood glucose (409.2 ± 132.5 mg/dL vs 423.7 ± 151.0 mg/dL, p = 0.446) were not different between the EndoTool versus fixed dosing groups. Initial insulin infusion rates were significantly higher for the EndoTool group compared to fixed dosing (9.1 ± 4.1 units/kg/hr vs 7.7 ± 2.7 units/kg/hr, p = 0.003), while average insulin infusion rates were not significantly different (8.0 ± 3.7 units/kg/hr vs 7.7 ± 2.7 units/kg/hr, p = 0.526). The incidence of hypoglycemic events was significantly lower in the EndoTool group compared to fixed dosing (0% vs 4.7%, p = 0.023).
Conclusions: In patients presenting to the ED with DKA or HHS, titration of insulin infusions using a glycemic control software such as EndoTool may be safer than fixed dosing. Further evaluations are needed to determine if there are efficacy benefits.