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[The optimal blood glucose target in critically ill patient: comparison of two intensive insulin therapy protocols].
Med Clin (Barc). 2014 Mar 04; 142(5):192-9.MC

Abstract

BACKGROUND AND OBJECTIVE

Recent studies in critically ill patients receiving insulin intravenous therapy (IIT) have shown an increased incidence of severe hypoglycemia, while intermittent subcutaneous insulin «sliding scales» (conventional insulin therapy [CIT]) is associated with hyperglycemia. The objective of this study is to assess whether glycemic control range IIT can affect glucose levels and their variability and to compare it with CIT.

PATIENTS AND METHOD

Prospective comparative cohort study in intensive care unit, with 2 study periods: Period 1, IIT with glycemic target range 110-140 mg/dL, and Period 2, IIT of 140-180 mg/dL. In both periods CIT glycemic target was 110-180 mg/dL. We assessed severe hypoglycemia (< 50 mg/dL), moderate hypoglycemia (51-79 mg/dL), hyperglycemia (> 216 mg/L) and the variability of blood glucose.

RESULTS

We studied 221 patients with 12.825 blood glucose determinations. Twenty-six and 17% of patients required IIT for glycemic control in Period 1 and 2, respectively. Hypoglycemia was associated with a discontinuous nutritional intake, glycemic target 110-140 mg/dL and low body mass index (BMI) (P = .002). Hyperglycemia was exclusively associated with a history of diabetes mellitus (OR 2.6 [95% CI 1.6 to 4.5]). Glycemic variability was associated with a discontinuous nutritional intake, low BMI, CIT insulinization, diabetes mellitus, elderly and high APACHE II (P < .001).

CONCLUSIONS

The use of IIT is useful to reduce the variability of blood glucose. Although the 140-180 mg/dL range would be more secure as to presenting greater variability and hyperglycemia, the 110-140 mg/dL range is most suitable.

Authors+Show Affiliations

Facultad de Enfermería, Universidad de Girona, Girona, España. Electronic address: martaraure@terra.es.Unidad de Cuidados Intensivos, Consorcio Hospitalario de Vic-Hospital General de Vic, Vic, Barcelona, España.Unidad de Cuidados Intensivos, Consorcio Hospitalario de Vic-Hospital General de Vic, Vic, Barcelona, España.Unidad de Cuidados Intensivos, Consorcio Hospitalario de Vic-Hospital General de Vic, Vic, Barcelona, España.Área de Vigilancia Intensiva, Hospital Clínic, Barcelona, España.

Pub Type(s)

Clinical Trial
Comparative Study
English Abstract
Journal Article
Research Support, Non-U.S. Gov't

Language

spa

PubMed ID

23490488

Citation

Raurell Torredà, Marta, et al. "[The Optimal Blood Glucose Target in Critically Ill Patient: Comparison of Two Intensive Insulin Therapy Protocols]." Medicina Clinica, vol. 142, no. 5, 2014, pp. 192-9.
Raurell Torredà M, del Llano Serrano C, Almirall Solsona D, et al. [The optimal blood glucose target in critically ill patient: comparison of two intensive insulin therapy protocols]. Med Clin (Barc). 2014;142(5):192-9.
Raurell Torredà, M., del Llano Serrano, C., Almirall Solsona, D., Catalan Ibars, R. M., & Nicolás Arfelis, J. M. (2014). [The optimal blood glucose target in critically ill patient: comparison of two intensive insulin therapy protocols]. Medicina Clinica, 142(5), 192-9. https://doi.org/10.1016/j.medcli.2012.11.032
Raurell Torredà M, et al. [The Optimal Blood Glucose Target in Critically Ill Patient: Comparison of Two Intensive Insulin Therapy Protocols]. Med Clin (Barc). 2014 Mar 4;142(5):192-9. PubMed PMID: 23490488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [The optimal blood glucose target in critically ill patient: comparison of two intensive insulin therapy protocols]. AU - Raurell Torredà,Marta, AU - del Llano Serrano,César, AU - Almirall Solsona,Dolors, AU - Catalan Ibars,Rosa María, AU - Nicolás Arfelis,José María, Y1 - 2013/03/13/ PY - 2012/09/10/received PY - 2012/11/28/revised PY - 2012/11/29/accepted PY - 2013/3/16/entrez PY - 2013/3/16/pubmed PY - 2015/5/15/medline KW - Blood glucose KW - Control glucémico KW - Critical care KW - Cuidados intensivos KW - Glucemia KW - Glycemic control KW - Hiperglucemia KW - Hipoglucemia KW - Hyperglycemia KW - Hypoglycemia KW - Insulin KW - Insulina SP - 192 EP - 9 JF - Medicina clinica JO - Med Clin (Barc) VL - 142 IS - 5 N2 - BACKGROUND AND OBJECTIVE: Recent studies in critically ill patients receiving insulin intravenous therapy (IIT) have shown an increased incidence of severe hypoglycemia, while intermittent subcutaneous insulin «sliding scales» (conventional insulin therapy [CIT]) is associated with hyperglycemia. The objective of this study is to assess whether glycemic control range IIT can affect glucose levels and their variability and to compare it with CIT. PATIENTS AND METHOD: Prospective comparative cohort study in intensive care unit, with 2 study periods: Period 1, IIT with glycemic target range 110-140 mg/dL, and Period 2, IIT of 140-180 mg/dL. In both periods CIT glycemic target was 110-180 mg/dL. We assessed severe hypoglycemia (< 50 mg/dL), moderate hypoglycemia (51-79 mg/dL), hyperglycemia (> 216 mg/L) and the variability of blood glucose. RESULTS: We studied 221 patients with 12.825 blood glucose determinations. Twenty-six and 17% of patients required IIT for glycemic control in Period 1 and 2, respectively. Hypoglycemia was associated with a discontinuous nutritional intake, glycemic target 110-140 mg/dL and low body mass index (BMI) (P = .002). Hyperglycemia was exclusively associated with a history of diabetes mellitus (OR 2.6 [95% CI 1.6 to 4.5]). Glycemic variability was associated with a discontinuous nutritional intake, low BMI, CIT insulinization, diabetes mellitus, elderly and high APACHE II (P < .001). CONCLUSIONS: The use of IIT is useful to reduce the variability of blood glucose. Although the 140-180 mg/dL range would be more secure as to presenting greater variability and hyperglycemia, the 110-140 mg/dL range is most suitable. SN - 1578-8989 UR - https://www.unboundmedicine.com/medline/citation/23490488/[The_optimal_blood_glucose_target_in_critically_ill_patient:_comparison_of_two_intensive_insulin_therapy_protocols]_ DB - PRIME DP - Unbound Medicine ER -