Insulin, Hyperglycemia, Research, Hypoglycemia, CMS Measure

Why it's time to get personal about the 15/15 rule

Today's health systems are inundated with protocols, processes and procedures for managing patient ailments and wellbeing during a hospital stay. So, it's no wonder providers rely on tried-and-true, generalized protocols for treatment. As technology progresses, however, is clinical inertia leading to worse outcomes?  

Let's explore this idea with the 15/15 rule. As the name suggests, the legacy glycemic management best practice states that 15 grams of oral carbohydrates will raise blood glucose by 50 mg/dL within 15 minutes. Glytec researchers tested the 15/15 methodology against a personalized IV D50 dose, and the results were telling.  

The analysis considered more than 10 million blood glucose readings in the Glytec national database from January 2017 to June 2021. After omitting patients that did not meet the study’s parameters, 57,629 <70 mg/dl events were included in the research. Nearly 30,000 events were managed with 15 grams of oral carbohydrates, and just over 27,500 were supported with personalized doses of IV D50.  

Key outcomes of this analysis included: 

  • In the oral carbohydrate group, 67% of subsequent blood glucose readings were in the target range of >70 mg/dL compared to almost 90% for the personalized group. 
  • In cases of severe hypoglycemia (<40 mg/dL), only 34.5% of oral carbohydrate events had a subsequent reading >70 mg/dL compared to 82.1% for the personalized group. 

The study suggests that 15 grams of carbohydrates may not be enough for patients with severe hyperglycemia. The 15/15 rule may be over. 

In addition, IV D50 doses should be precise and individualized, with support from a computerized dosing algorithm to deliver improved patient outcomes compared to generalized legacy practices.  

Health systems are already under increased pressure from the Centers for Medicare & Medicaid Services (CMS)' new severe hypoglycemia measure. These revelations come less than six months from when hospitals are set to begin reporting their own performance. Additionally, leading industry experts, like the ADA, have suggested using computerized dosing protocols that allow for predefined adjustments in insulin dosage based on glycemic fluctuations for years. The evidence has made it clear that technology will only continue to play a significant role when it comes to blood glucose management. 

To learn more about how personalized insulin doses can help improve patient outcomes, watch Dr. Jordan Messler explore the research in more detail: 


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