Hypoglycemia Prediction Model

University of California San Francisco (UCSF)

Status: Completed

Conditions: Hypoglycemia

Treatments: Other: Hypoglycemia prediction alert

Study type: Interventional

Funder types: Other

Identifiers

NCT03006510

16-20565

Details and patient eligibility

About

Our goal for this Learning Healthcare System Demonstration Project is to reduce the rate of inpatient hypoglycemia. Hypoglycemia can result in longer lengths of stay and increased morbidity and mortality (ie falls and cardiovascular or cerebral events).

The group at Washington University (WSL) developed a predictive hypoglycemia risk score. Using current glucose, body weight, creatinine clearance, insulin type and dosing, and oral diabetic therapy, they identified patients at high risk for hypoglycemia and then provided in-person education to the providers of these patients. This resulted in a 68% reduction in severe hypoglycemia (blood glucose < 40 mg/dL). This approach required significant personnel hours and is difficult to replicate in other systems.

The investigators will implement an EHR-based intervention at UCSF to predict which patients are at high risk of inpatient hypoglycemia and take action to prevent the hypoglycemic event. In real time, all adult (non OB) patients with a glucose < 90, and a high risk of future hypoglycemia (based on the WSL formula) will be identified. Patients will be randomly assigned to intervention or no intervention (current standard care). The intervention will consist of an automated provider alert with recommendations on what adjustments could be made to avoid a potentially serious hypoglycemic event.

The outcomes that will be measured include: 1) reductions in serious hypoglycemic events, 2) monitor the changes made by providers as a result of alerts in order to study provider behavior and identify future areas of intervention, and 3) provider satisfaction with the alert system.

Enrollment: 498 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All adult inpatients having glucoses measured (point of care)

Exclusion criteria

• adults admitted to obstetrics

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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498 participants in 2 patient groups

Alert

Active Comparator group

Description:

If glucose \<90 mg/dl and hypoglycemia prediction score \>35, then alert with suggestion for intervention sent to treating team

Treatment:

Other: Hypoglycemia prediction alert

No alert

No Intervention group

Description:

Routine standard care. If glucose \<90 mg/dl and hypoglycemia prediction score \>35, then report for investigators will be collected, but no active alert will be sent to teams.