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Intensive insulin therapy in practice: can we do it?
JPEN J Parenter Enteral Nutr. 2009 Jan-Feb; 33(1):14-20.JJ

Abstract

BACKGROUND

Intensive insulin therapy (IIT) is the standard of care in the ICU, but precise implementation of insulin protocols has been difficult in clinical practice. The authors' objective was to quantify adherence to an IIT protocol in a practice setting, and to describe how adherence impacts overall blood glucose (BG) control.

METHODS

A retrospective analysis of a cohort of critically ill patients treated with IIT was performed. Protocol adherence was evaluated by assessing the timing of BG measurements. Each measurement was categorized according to the time from the previous reading: early (<1 hour), on time (1-3 hours), and late (>3 hours). Outcome measures included mean and median BG for each time category as well as the proportion of values within the target range.

RESULTS

In 1106 trauma and surgical ICU patients, 54,139 measurements were available for analysis. The overall mean BG (116 mg/dL) was near the target (80-110 mg/dL), but only 46% of values were within this range. There were 45,806 (86%) measurements on time, 2749 (5%) early, and 4478 (9%) were late. BG values of late measurements were less likely to be within range (34% vs 46% for on time measurements, P<.001). Of late measurements, 19% were >200 mg/dL, 13% were 150-200 mg/dL, and 16% were <60 mg/dL.

CONCLUSIONS

IIT is difficult to implement precisely in a complex ICU environment. Measurement timing impacts overall BG control, with late measurements more often associated with severe hyperglycemic (BG>150 mg/dL) and hypoglycemic (BG<60 mg/dL) episodes.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Dossett LA
Division of Trauma & Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. lesly.dosset@vanderbilt.edu
Collier B
No affiliation info available
Donahue R
No affiliation info available
Mowery NT
No affiliation info available
Dortch MJ
No affiliation info available
Guillamondegui O
No affiliation info available
Diaz JJ
No affiliation info available
May AK
No affiliation info available

MeSH

AdultAgedBlood GlucoseClinical ProtocolsCritical CareCritical IllnessDrug Administration ScheduleFemaleGuideline AdherenceHumansHyperglycemiaHypoglycemic AgentsInsulinIntensive Care UnitsMaleMiddle AgedRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18832598

Citation

Dossett, Lesly A., et al. "Intensive Insulin Therapy in Practice: Can We Do It?" JPEN. Journal of Parenteral and Enteral Nutrition, vol. 33, no. 1, 2009, pp. 14-20.
Dossett LA, Collier B, Donahue R, et al. Intensive insulin therapy in practice: can we do it? JPEN J Parenter Enteral Nutr. 2009;33(1):14-20.
Dossett, L. A., Collier, B., Donahue, R., Mowery, N. T., Dortch, M. J., Guillamondegui, O., Diaz, J. J., & May, A. K. (2009). Intensive insulin therapy in practice: can we do it? JPEN. Journal of Parenteral and Enteral Nutrition, 33(1), 14-20. https://doi.org/10.1177/0148607108321703
Dossett LA, et al. Intensive Insulin Therapy in Practice: Can We Do It. JPEN J Parenter Enteral Nutr. 2009;33(1):14-20. PubMed PMID: 18832598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive insulin therapy in practice: can we do it? AU - Dossett,Lesly A, AU - Collier,Bryan, AU - Donahue,Rafe, AU - Mowery,Nathan T, AU - Dortch,Marcus J, AU - Guillamondegui,Oscar, AU - Diaz,Jose J, AU - May,Addison K, Y1 - 2008/10/02/ PY - 2008/10/4/pubmed PY - 2009/2/20/medline PY - 2008/10/4/entrez SP - 14 EP - 20 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 33 IS - 1 N2 - BACKGROUND: Intensive insulin therapy (IIT) is the standard of care in the ICU, but precise implementation of insulin protocols has been difficult in clinical practice. The authors' objective was to quantify adherence to an IIT protocol in a practice setting, and to describe how adherence impacts overall blood glucose (BG) control. METHODS: A retrospective analysis of a cohort of critically ill patients treated with IIT was performed. Protocol adherence was evaluated by assessing the timing of BG measurements. Each measurement was categorized according to the time from the previous reading: early (<1 hour), on time (1-3 hours), and late (>3 hours). Outcome measures included mean and median BG for each time category as well as the proportion of values within the target range. RESULTS: In 1106 trauma and surgical ICU patients, 54,139 measurements were available for analysis. The overall mean BG (116 mg/dL) was near the target (80-110 mg/dL), but only 46% of values were within this range. There were 45,806 (86%) measurements on time, 2749 (5%) early, and 4478 (9%) were late. BG values of late measurements were less likely to be within range (34% vs 46% for on time measurements, P<.001). Of late measurements, 19% were >200 mg/dL, 13% were 150-200 mg/dL, and 16% were <60 mg/dL. CONCLUSIONS: IIT is difficult to implement precisely in a complex ICU environment. Measurement timing impacts overall BG control, with late measurements more often associated with severe hyperglycemic (BG>150 mg/dL) and hypoglycemic (BG<60 mg/dL) episodes. SN - 0148-6071 UR - https://www.unboundmedicine.com/medline/citation/18832598/Intensive_insulin_therapy_in_practice:_can_we_do_it DB - PRIME DP - Unbound Medicine ER -