Clinical trials or observational studies that involved critically ill adult patients and that evaluated tight glycaemic control protocols with a CDSS were eligible for inclusion in the review. Tight glycaemic control protocols had to provide an upper normoglycaemia limit of no more than 150mg/dL to be eligible for inclusion. Opinion papers, surveys and letters were excluded from the review.
Outcomes included the effects of CDSS on the quality of tight glycaemic control process or mortality or morbidity. Other outcomes of interest related to study design, CDSS characteristics and quality indicators used to define glycaemic control.
Included participants were from medical intensive care, cardiothoracic intensive care unit and trauma admission. Patients underwent treatment for a range of medical conditions. Tight glycaemic control target ranges were 72mg/dL to 150mg/dL. Monitoring intervals were 15 minutes to 24 hours (or not mentioned). All CDSS were patient specific and operated in the critique mode. Most CDSSs were standalone and not integrated into other information systems. Most CDSS protocols were formula-based; others were based on if-then protocols. Just over half of the studies sent automatic reminders to users about time of next blood glucose level check. Most users manually entered the data into a separate CDSS system. Many different indicators of glycaemic control were used (most common was blood glucose level). Nearly all included studies used hypoglycaemia-related indicators as a proxy for safety. Most studies evaluated the effect of a new tight glycaemic control protocol introduced at the same time as CDSS.
Two reviewers independently selected studies for inclusion in the review. Discrepancies were resolved by consensus with a third reviewer.