Intensive Insulin Therapy in Practice: Can We Do It?

Background: Intensive insulin therapy (IIT) is the standard of care in the ICU, but precise implementation of insulin protocols has been difficult in clinical practice. The authors' objective was to quantify adherence to an IIT protocol in a practice setting, and to describe how adherence impac...

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Bibliographic Details
Published in:JPEN. Journal of parenteral and enteral nutrition 2009-01, Vol.33 (1), p.14-20
Main Authors: Dossett, Lesly A., Collier, Bryan, Donahue, Rafe, Mowery, Nathan T., Dortch, Marcus J., Guillamondegui, Oscar, Diaz, Jose J., May, Addison K.
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood Glucose - analysis
Clinical Protocols
critical care
Critical Care - methods
Critical Illness - therapy
Drug Administration Schedule
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Female
Glucose
Guideline Adherence
Humans
hyperglycemia
Hyperglycemia - drug therapy
hypoglycemia
Hypoglycemic Agents - administration & dosage
Hypoglycemic Agents - adverse effects
Hypoglycemic Agents - therapeutic use
Insulin - administration & dosage
Insulin - adverse effects
Insulin - therapeutic use
Intensive care medicine
Intensive Care Units - standards
intensive insulin therapy
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
protocol adherence
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Respiratory system
Retrospective Studies
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Summary:Background: Intensive insulin therapy (IIT) is the standard of care in the ICU, but precise implementation of insulin protocols has been difficult in clinical practice. The authors' objective was to quantify adherence to an IIT protocol in a practice setting, and to describe how adherence impacts overall blood glucose (BG) control. Methods: A retrospective analysis of a cohort of critically ill patients treated with IIT was performed. Protocol adherence was evaluated by assessing the timing of BG measurements. Each measurement was categorized according to the time from the previous reading: early (3 hours). Outcome measures included mean and median BG for each time category as well as the proportion of values within the target range. Results: In 1106 trauma and surgical ICU patients, 54,139 measurements were available for analysis. The overall mean BG (116 mg/dL) was near the target (80-110 mg/dL), but only 46% of values were within this range. There were 45,806 (86%) measurements on time, 2749 (5%) early, and 4478 (9%) were late. BG values of late measurements were less likely to be within range (34% vs 46% for on time measurements, P < .001). Of late measurements, 19% were >200 mg/dL, 13% were 150-200 mg/dL, and 16% were 150 mg/dL) and hypoglycemic (BG < 60 mg/dL) episodes.
ISSN:0148-6071
1941-2444
DOI:10.1177/0148607108321703