Multicenter Comparison of Insulin Sensitivity Coefficient vs Paper Intravenous Insulin Protocols

Sunday, March 22, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 01

Amy K. Janowski, PharmD (she/her/hers)

Brigham and Women's Hospital, Massachusetts

Disclosure(s): No relevant financial relationship(s) to disclose.
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Nandini Patel, PharmD, BCCCP

Critical Care Clinical Pharmacy Manager
Mount Sinai

Disclosure information not submitted.
Lydia Ware, PharmD (she/her/hers)

Brigham and Women's Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.
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Kevin Dube, PharmD, BCCCP, BCPS

Pharmacist
Brigham & Women's Hospital

Disclosure information not submitted.
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Mary Dube, PharmD, BCCCP, BCPS

Clinical Pharmacy Specialist, Medication Safety
Brigham & Women's Hospital

Disclosure information not submitted.
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Kenneth Lupi, PharmD, BCCCP, BCPS

Clinical Pharmacy Manager
Brigham & Women's Hospital

Disclosure information not submitted.
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Anne Bane, MSN, RN, BC

Nurse Director, Nursing Informatics and Medication Safety
Brigham & Women's Hospital

Disclosure information not submitted.
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Paul Szumita, PharmD, FCCM, FASHP, BCCCP, BCPS

Director of Clinical Pharmacy Services
Brigham and Women's Hospital

Disclosure information not submitted.
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Nadine Palermo, DO

Associate Director of Acute Diabetes Care
Brigham & Women's Hospital

Disclosure information not submitted.
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Andrew Tom, PharmD, BCCP

Critical Care Pharmacist
Massachusetts General Hospital

Disclosure information not submitted.
Russel J. Roberts, PharmD, BCCCP, FCCM (he/him/his)

Massachusetts General Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.
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Jeremy DeGrado, PharmD, BCCCP

Clinical Pharmacy Manager
Brigham & Women's Hospital

Disclosure information not submitted.

Introduction: Computerized intravenous (IV) insulin infusion calculators may offer a safe and efficacious means of achieving glycemic control. Historically, our health system utilized various multiplication factor and fixed-dose, 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 the previous protocols.

Methods: This was a pre-post intervention analysis (IRB Protocol #2023P002213) of 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. Patients were excluded if the indication was hyperglycemic emergencies, hypertriglyceridemia, hyperkalemia, or hyperglycemia management in obstetric patients. The major endpoint 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, 503 patients were evaluated for inclusion, of which 207 and 237 patients were included in the pre-intervention and post-intervention groups, respectively. The most common reason for exclusion was the use of IV insulin for hyperglycemia emergencies. A total of 14,183 blood glucose values were assessed between the pre- and post-intervention groups. For the major outcome, 4,610 of 6,313 (73%) and 6,163 of 7,870 (78.3%) of blood glucose values were in range in the pre- and post-intervention groups, respectively (p < 0.01). There was no statistical difference in severe hypoglycemia (0.2% vs. 0.1%, p=0.24), but hyperglycemia (16.6% vs. 12.6%, p< 0.01), severe hyperglycemia (5.7% vs. 4.0%, p< 0.01), and hypoglycemia (0.7% vs. 0.2%, p< 0.01) were significantly more common in the pre-intervention group.

Conclusions: A computerized ISC-based insulin infusion protocol resulted in more blood glucose values within target range and lower rates of hypoglycemia compared to paper-based IV insulin infusion protocols.