Tight Glycemic Control Protocols Research Articles

Implementation of a tight glycaemic control protocol using a web‐based insulin dose calculator

We describe the implementation of a glucose control protocol supported by a web-based insulin dose calculator in a 16-bedded intensive care unit. The protocol was introduced and then modified after 15 months' use. Glucose concentrations were retrospectively reviewed and compared for the 9-month period before introduction of the protocol (288 patients), for 15 months after its introduction (502 patients) and for a further 5 months after its modification to increase insulin dose (101 patients). The mean (SD) blood glucose concentrations decreased from 7.3 (1.8) mmol.l(-1) to 6.6 (1.6) mmol.l(-1) and then to 6.2 (1.3) mmol.l(-1). The proportion of values < 8.0 mmol.l(-1) increased from 69% to 81% and then to 89%. Blood glucose concentrations were increased by the use of intravenous nutrition and by vasoactive drugs but not by the administration of propofol. The odds ratio [95% CI] for death for glucose values > 8.0 mmol.l(-1) was 2.10 [1.19-3.73] compared to values < 6.1 mmol.l(-1). However, patient mortality remained constant during the study. Glycaemic control was improved outside a research setting using a protocol supported by a web-based insulin dose calculator.

Tight glycemic control increases the incidence of hypoglycemia in intensive care unit patients

Hyperglycemia is common in critically ill patients. Tight glycemic control (aimed at blood glucose levels of 4.4–6.1 mmol/l) improved the mortality and morbidity in postoperative intensive care patients [1]. Tight glycemic control, however, bares the risk of hypoglycemia. The present study was performed to investigate whether the introduction of a nurse-driven tight glycemic control protocol in two general ICUs increases the incidence of (severe) hypoglycemia.