The inclusion of a computer-guided program (Glucommander) as a component of diabetic ketoacidosis management was associated with significantly less hypoglycemia and faster time to normalization of blood glucose and bicarbonate than standard treatment of diabetic ketoacidosis, according to a new retrospective multicenter study.

The study also demonstrated a significant difference in length of hospital stay for patients treated with Glucommander compared with standard protocol (3.2 vs 4.5 days).

“This is the largest study that has made this comparison,” said study investigator Joseph Aloi, MD, professor of medicine and the chief of endocrinology and metabolism at Wake Forest School of Medicine, Winston Salem, North Carolina. “We knew we could impact it and we looked at it in a smaller number of patients. It is very reassuring that we got the same result. It was almost exactly the same.”

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Continuous insulin infusion (CII) is widely accepted as the standard of care for the treatment of patients with diabetic ketoacidosis, Dr Aloi explained. He noted that there are several paper form-based and computer-based algorithms that have been shown to be beneficial in the management of hyperglycemia in critically ill patients. However, it is unknown if computer-based algorithms are superior to standard protocols in the management of patients with diabetic ketoacidosis.

The researchers analyzed data on 2665 patients. The group consisted of 1750 patients with diabetic ketoacidosis treated with the Glucommander computer-guided program and 915 patients with diabetic ketoacidosis treated with standard protocols. The patients were seen at 34 medical institutions in the United States and researchers examined the differences in time to resolution of hyperglycemia (blood glucose lower than 200 mg/dL) and acidosis (serum bicarbonate lower than 18 mmol/L) as well as the number of hypoglycemic events (blood glucose lower than 70 mg/dL and lower than 40 mg/dL). 

In this study, the average blood glucose level was higher on presentation in the Glucommander group than the standard protocol group (598 mg/dL vs 425 mg/dL). Another difference was noted in serum bicarbonate levels. They were lower in the Glucommander group than the standard protocol group (13.6 mmol/L vs 17.3 mmol/L).

The researchers found that those using the Glucommander led to a shorter time to achieving blood glucose levels lower than 200 mg/dL (9.1 vs 11.0 hours). Additionally, fewer hypoglycemic events were observed in the Glucommander group. The study showed that 13% in the Glucommander group had blood glucose lower than 70 mg/dL compared with 35% in the standard protocol group, and 0.5% in the Glucommander group had a blood glucose lower than 40 mg/dL compared with 6.6% in the standard protocol group.

The benefit also extended into a shorter median length of hospital stay (3.2 vs 4.5 days).

“It translates into more seamless care of the patient,” Dr Aloi said. “It is easier for the nursing staff. It is less work for the nurse at the bedside and less opportunity for errors.”

The researchers noted that prospective randomized clinical trials are warranted. They suggested that these trials prospectively compare the safety, efficacy, and costs of computer-based algorithms with the current standard of care.

This article originally appeared on as a part of their coverage of the 2016 AACE Annual Scientific and Clinical Congress. 


  1. Aloi J, Hebblewhite H, Ullal J, et al. Abstract 1302. Comparison of a Computer-Guided Versus Standard Insulin Infusion Regimens in Patients With Diabetic Ketoacidosis. Presented at: AACE 25th Annual Scientific & Clinical Congress; May 25-29, 2016; Orlando, FL.