304

Abstract

Introduction: Although insulin infusion therapy (IIT) is standard for hyperglycemia management in the intensive care unit (ICU), this approach is associated with a significant risk of hypoglycemia. With rising concern regarding negative outcomes related to hypoglycemia, the existing institutional IIT paper protocol was revised to minimize risk of hypoglycemia, and this protocol was piloted in the ICUs for 6 months. The primary objective of this study was to determine the impact of the revised IIT protocol on the incidence of hypoglycemia. Hypothesis: A revised IIT protocol will reduce the incidence of hypoglycemia. Methods: A retrospective study was conducted to compare patients who received IIT pre- and post-implementation of the revised protocol. Patients aged 18-89 years who received IIT in the ICU were eligible for inclusion. Patients in the pre-group were admitted September 15, 2010-March 15, 2011, and in the post-group September 15, 2011-March 15, 2012, during the pilot period. The primary endpoint was the incidence of hypoglycemia (glucose <70 mg/dl). Secondary endpoints included mean glucose while on IIT and time to glucose control. Continuous data were analyzed using the Mann-Whitney U test and nominal data using the Chi-square test. Statistical significance was set at alpha 0.05. Results: Four hundred eighty six patients were evaluated with 264 pre- and 222 post-implementation patients. The post-implementation group had a significantly lower rate of hypoglycemia (34.5 vs. 22.1%, p=0.003). There was no significant difference in time to glucose control between the pre- and post-groups (6.18 [4.07-10] vs. 6.16 [3.77-9.65] hours, p=0.339). In addition, the median of the mean glucoses was similar between the pre-and post-groups (152.7 [139-171.8] vs. 157.1 [144.4-175.2], p=0.067). Conclusions: Revision of the IIT protocol resulted in a reduction in hypoglycemia without negatively impacting mean glucose and time to glucose control. While computerized programs exist to assist in implementation of complicated IIT algorithms, simple quality control and revision of existing paper protocols can also be effective in improving the safety of IIT.