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Management of diabetes mellitus and hospital-related hyperglycemia in patients of a medical ICU, with the use of two "down-to-earth" protocols: a feasibility study.
Exp Clin Endocrinol Diabetes. 2007 Oct; 115(9):577-83.EC

Abstract

OBJECTIVE

Optimal control of blood glucose in the ICU has been shown to significantly decrease mortality and morbidity of severely ill patients. The purpose of the present project was to develop and implement undemanding, "down-to-earth" protocols, enabling tight glucose control in critically ill patients, in the setting of a city hospital ICU with limited personnel and facilities.

RESEARCH DESIGN AND METHODS

From January 2003 to January 2006, a total of 745 patients (3197 patient-days) were treated for hyperglycemia in our medical ICU. On July 2003 two different intensive insulin therapy protocols were implemented: A protocol of continuous intravenous insulin, including specific algorithms for calculation of initial insulin bolus, initial infusion rate and further adjustment plan, was used for patients with compromised peripheral tissue perfusion. For patients with stable circulation, a protocol of subcutaneous intensive insulin therapy, including a formula for calculation of daily insulin dosage in previously non-insulin-treated diabetics, was adopted. 134 patients were treated during the run-in phase of the project and 539 patients were treated during the main treatment phase. 72 patients treated for hyperglycemia in our ICU prior to the implementation of the two protocols (from January 2003 to July 2003) served as controls.

RESULTS

After the implementation of the two protocols, a marked overall increase of normoglycemic blood glucose values (64.7% vs. 48.5%, P<0.001), a decrease of manifest hyperglycemias (6.4% vs. 17.4%, P<0.001) and an increase in hypoglycemic events (1.8% vs. 0.7%, P<0.001) was observed. Seven cases of severe hypoglycemia requiring glucose infusion were observed during the main treatment phase (0.3%). No hypoglycemia-associated deaths occurred.

CONCLUSIONS

The combined implementation of the two protocols presents a simple, safe and effective way of pursuing normoglycemia in critically ill patients.

Authors+Show Affiliations

Klinikum Hannover Nordstadt, Medizinische Klinik, Department of Medicine, Krankenhaus Nordstadt, Klinikum Region Hannover, Hannover, Germany. johannes.hensen.nordstadt@krh.euNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17943691

Citation

Hensen, J, et al. "Management of Diabetes Mellitus and Hospital-related Hyperglycemia in Patients of a Medical ICU, With the Use of Two "down-to-earth" Protocols: a Feasibility Study." Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association, vol. 115, no. 9, 2007, pp. 577-83.
Hensen J, Thomas T, Mueller-Ziehm J, et al. Management of diabetes mellitus and hospital-related hyperglycemia in patients of a medical ICU, with the use of two "down-to-earth" protocols: a feasibility study. Exp Clin Endocrinol Diabetes. 2007;115(9):577-83.
Hensen, J., Thomas, T., Mueller-Ziehm, J., Worthmann, W., Kleine, E., & Behrens, E. M. (2007). Management of diabetes mellitus and hospital-related hyperglycemia in patients of a medical ICU, with the use of two "down-to-earth" protocols: a feasibility study. Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association, 115(9), 577-83.
Hensen J, et al. Management of Diabetes Mellitus and Hospital-related Hyperglycemia in Patients of a Medical ICU, With the Use of Two "down-to-earth" Protocols: a Feasibility Study. Exp Clin Endocrinol Diabetes. 2007;115(9):577-83. PubMed PMID: 17943691.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of diabetes mellitus and hospital-related hyperglycemia in patients of a medical ICU, with the use of two "down-to-earth" protocols: a feasibility study. AU - Hensen,J, AU - Thomas,T, AU - Mueller-Ziehm,J, AU - Worthmann,W, AU - Kleine,E, AU - Behrens,E-M, PY - 2007/10/19/pubmed PY - 2008/1/23/medline PY - 2007/10/19/entrez SP - 577 EP - 83 JF - Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association JO - Exp Clin Endocrinol Diabetes VL - 115 IS - 9 N2 - OBJECTIVE: Optimal control of blood glucose in the ICU has been shown to significantly decrease mortality and morbidity of severely ill patients. The purpose of the present project was to develop and implement undemanding, "down-to-earth" protocols, enabling tight glucose control in critically ill patients, in the setting of a city hospital ICU with limited personnel and facilities. RESEARCH DESIGN AND METHODS: From January 2003 to January 2006, a total of 745 patients (3197 patient-days) were treated for hyperglycemia in our medical ICU. On July 2003 two different intensive insulin therapy protocols were implemented: A protocol of continuous intravenous insulin, including specific algorithms for calculation of initial insulin bolus, initial infusion rate and further adjustment plan, was used for patients with compromised peripheral tissue perfusion. For patients with stable circulation, a protocol of subcutaneous intensive insulin therapy, including a formula for calculation of daily insulin dosage in previously non-insulin-treated diabetics, was adopted. 134 patients were treated during the run-in phase of the project and 539 patients were treated during the main treatment phase. 72 patients treated for hyperglycemia in our ICU prior to the implementation of the two protocols (from January 2003 to July 2003) served as controls. RESULTS: After the implementation of the two protocols, a marked overall increase of normoglycemic blood glucose values (64.7% vs. 48.5%, P<0.001), a decrease of manifest hyperglycemias (6.4% vs. 17.4%, P<0.001) and an increase in hypoglycemic events (1.8% vs. 0.7%, P<0.001) was observed. Seven cases of severe hypoglycemia requiring glucose infusion were observed during the main treatment phase (0.3%). No hypoglycemia-associated deaths occurred. CONCLUSIONS: The combined implementation of the two protocols presents a simple, safe and effective way of pursuing normoglycemia in critically ill patients. SN - 0947-7349 UR - https://www.unboundmedicine.com/medline/citation/17943691/Management_of_diabetes_mellitus_and_hospital_related_hyperglycemia_in_patients_of_a_medical_ICU_with_the_use_of_two_"down_to_earth"_protocols:_a_feasibility_study_ L2 - https://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-980177 DB - PRIME DP - Unbound Medicine ER -