The Efficacy and Safety of an Insulin Infusion Protocol in a Medical Intensive Care Unit at a Tertiary Care Hospital: a Prospective Study

Abstract

To evaluate the efficacy and safety of a modified insulin infusion protocol, targeting a blood glucose level of 140–180 mg/dL, in a medical intensive care unit at a tertiary care university hospital. We compared glycemic control parameters before and after using the KCMH insulin infusion protocol in a MICU (pre- and post-protocol groups). In the pre-protocol group, hyperglycemia was managed by conventional care. In the post-protocol group, hyperglycemia was managed according to the KCMH protocol. Study outcomes were a proportion of patients achieving a glycemic target of 140–180 mg/dL within 8 h after initiation of an insulin infusion, various glycemic control parameters, and clinical outcomes. Twenty-eight patients were in the pre-protocol group, and 27 were in the post-protocol group. The proportion of patients achieving a glycemic target within 8 h after initiation of an insulin infusion was significantly higher in the post-protocol group compared to the pre-protocol group (70.4% vs. 21.4%, p < 0.001). Patients in the post-protocol group achieved a blood glucose target faster than the pre-protocol group (7.4 ± 4.1 h vs. 12.5 ± 7.5 h, p = 0.004). Mean blood glucose levels during insulin infusion were significantly lower in the post-protocol group compared to the pre-protocol group (170.9 ± 15.3 mg/dL vs. 205.6 ± 46.7 mg/dL, p = 0.001). The glycemic variability indices were also better in the post-protocol group. Implementation of a KCMH insulin infusion protocol in a medical ICU resulted in better glycemic control than conventional care without excess risk of hypoglycemia. The study was approved by the Institutional Review Board and Thai Clinical Trial Registry (clinicaltrials.in.th: TCTR20161105001).