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Adherence to and efficacy and safety of an insulin protocol in the critically ill: a prospective observational study.
Am J Crit Care. 2007 Nov; 16(6):599-608.AJ

Abstract

BACKGROUND

Blood glucose control during acute illness has been associated with improved outcomes.

OBJECTIVES

To evaluate adherence to and efficacy and safety of an insulin protocol for critically ill patients with target blood glucose levels between 81 and 110 mg/dL and to determine factors associated with adequate daily blood glucose control.

METHODS

In a prospective observational study, blood glucose levels were determined in 30 patients in intensive care units of a tertiary care university hospital during a 2-month period. All glucose measurements and corresponding insulin infusion rates were evaluated for adherence to and efficacy and safety of the insulin protocol. Linear regression analysis was used to determine factors associated with adequate daily blood glucose control, defined as time in the target range.

RESULTS

A total of 6016 blood glucose measurements were obtained during 352 protocol implementation days. Adherence to the protocol was 71%. Blood glucose levels were in the desired range 42% of the total protocol implementation time. Sixty percent of the patients experienced at least one hypoglycemic event. Adherence to the protocol (P < .001), high bilirubin level (P < .001), low daily insulin dose (P = .002), and low C-reactive protein level (P = .048) were independently associated with adequate daily blood glucose control.

CONCLUSIONS

Protocol adherence was positively associated with daily time in the target range, but efficacy during the total protocol implementation time remained poor. Because of the frequency of hypoglycemia, protocols to maintain blood glucose levels between 81 and 110 mg/dL in critically ill patients may not be recommended.

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Authors+Show Affiliations

Oeyen SG
Department of Intensive Care, Ghent University Hospital, Ghent, Belgium. Sandra.Oeyen@UGent.be
Hoste EA
No affiliation info available
Roosens CD
No affiliation info available
Decruyenaere JM
No affiliation info available
Blot SI
No affiliation info available

MeSH

AdultAgedAged, 80 and overBelgiumBlood GlucoseClinical ProtocolsFemaleGuideline AdherenceHumansHyperglycemiaHypoglycemiaInsulinIntensive Care UnitsMaleMiddle AgedNursing AuditObservationProspective StudiesSafety ManagementTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17962504

Citation

Oeyen, Sandra G., et al. "Adherence to and Efficacy and Safety of an Insulin Protocol in the Critically Ill: a Prospective Observational Study." American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses, vol. 16, no. 6, 2007, pp. 599-608.
Oeyen SG, Hoste EA, Roosens CD, et al. Adherence to and efficacy and safety of an insulin protocol in the critically ill: a prospective observational study. Am J Crit Care. 2007;16(6):599-608.
Oeyen, S. G., Hoste, E. A., Roosens, C. D., Decruyenaere, J. M., & Blot, S. I. (2007). Adherence to and efficacy and safety of an insulin protocol in the critically ill: a prospective observational study. American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses, 16(6), 599-608.
Oeyen SG, et al. Adherence to and Efficacy and Safety of an Insulin Protocol in the Critically Ill: a Prospective Observational Study. Am J Crit Care. 2007;16(6):599-608. PubMed PMID: 17962504.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adherence to and efficacy and safety of an insulin protocol in the critically ill: a prospective observational study. AU - Oeyen,Sandra G, AU - Hoste,Eric A, AU - Roosens,Carl D, AU - Decruyenaere,Johan M, AU - Blot,Stijn I, PY - 2007/10/27/pubmed PY - 2008/3/12/medline PY - 2007/10/27/entrez SP - 599 EP - 608 JF - American journal of critical care : an official publication, American Association of Critical-Care Nurses JO - Am J Crit Care VL - 16 IS - 6 N2 - BACKGROUND: Blood glucose control during acute illness has been associated with improved outcomes. OBJECTIVES: To evaluate adherence to and efficacy and safety of an insulin protocol for critically ill patients with target blood glucose levels between 81 and 110 mg/dL and to determine factors associated with adequate daily blood glucose control. METHODS: In a prospective observational study, blood glucose levels were determined in 30 patients in intensive care units of a tertiary care university hospital during a 2-month period. All glucose measurements and corresponding insulin infusion rates were evaluated for adherence to and efficacy and safety of the insulin protocol. Linear regression analysis was used to determine factors associated with adequate daily blood glucose control, defined as time in the target range. RESULTS: A total of 6016 blood glucose measurements were obtained during 352 protocol implementation days. Adherence to the protocol was 71%. Blood glucose levels were in the desired range 42% of the total protocol implementation time. Sixty percent of the patients experienced at least one hypoglycemic event. Adherence to the protocol (P < .001), high bilirubin level (P < .001), low daily insulin dose (P = .002), and low C-reactive protein level (P = .048) were independently associated with adequate daily blood glucose control. CONCLUSIONS: Protocol adherence was positively associated with daily time in the target range, but efficacy during the total protocol implementation time remained poor. Because of the frequency of hypoglycemia, protocols to maintain blood glucose levels between 81 and 110 mg/dL in critically ill patients may not be recommended. SN - 1062-3264 UR - https://www.unboundmedicine.com/medline/citation/17962504/Adherence_to_and_efficacy_and_safety_of_an_insulin_protocol_in_the_critically_ill:_a_prospective_observational_study_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=17962504.ui DB - PRIME DP - Unbound Medicine ER -