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Improved safety with intravenous insulin therapy for critically ill patients with renal failure.
Nutrition. 2014 May; 30(5):557-62.N

Abstract

OBJECTIVE

The aim of this study was to evaluate the safety and efficacy of a new intravenous (IV) regular human insulin infusion (RHI) algorithm for glycemic control in critically ill patients with renal failure.

METHODS

Adult trauma patients with renal failure who received a new RHI algorithm were compared with those who received the discontinued RHI algorithm (historical control). Target blood glucose (BG) concentration was 70 to 149 mg/dL (3.9-8.3 mmol/L). Patients were evaluated for 7 d while receiving the RHI infusion and continuous enteral or parenteral nutrition.

RESULTS

Mean BG was higher for the new RHI algorithm group (n = 25) compared with control (n = 21): 145 ± 10 mg/dL or 8.1 ± 0.6 mmol/L versus 133 ± 14 mg/dL or 7.4 ± 0.8 mmol/L (P = 0.001). The new RHI algorithm resulted in less time within the target BG range (11.9 ± 2.5 h/d versus 16.1 ± 3.3 h/d; P = 0.001); however, BGs were within 70 to 179 mg/dL (or 3.9-10 mmol/L) for 16.3 ± 2.6 h/d. The proportion of patients who experienced an episode of moderate hypoglycemia (BG 40-60 mg/dL or 2.2-3.3 mmol/L) or severe hypoglycemia (BG < 40 mg/dL or 2.2 mmol/L) was decreased (32% versus 76%; P = 0.001) and eliminated (0% versus 29%, P = 0.006), respectively.

CONCLUSIONS

The new RHI algorithm improved patient safety by decreasing the prevalence of moderate hypoglycemia and eliminating severe hypoglycemia. The duration of glycemic control within the target BG range was decreased, but acceptable within a higher target BG ceiling.

Authors+Show Affiliations

Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA. Electronic address: Rdickerson@uthsc.edu.Department of Pharmacy, Duke University Hospital, Durham, NC, USA.Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

24296035

Citation

Dickerson, Roland N., et al. "Improved Safety With Intravenous Insulin Therapy for Critically Ill Patients With Renal Failure." Nutrition (Burbank, Los Angeles County, Calif.), vol. 30, no. 5, 2014, pp. 557-62.
Dickerson RN, Lynch AM, Maish GO, et al. Improved safety with intravenous insulin therapy for critically ill patients with renal failure. Nutrition. 2014;30(5):557-62.
Dickerson, R. N., Lynch, A. M., Maish, G. O., Croce, M. A., Minard, G., & Brown, R. O. (2014). Improved safety with intravenous insulin therapy for critically ill patients with renal failure. Nutrition (Burbank, Los Angeles County, Calif.), 30(5), 557-62. https://doi.org/10.1016/j.nut.2013.10.010
Dickerson RN, et al. Improved Safety With Intravenous Insulin Therapy for Critically Ill Patients With Renal Failure. Nutrition. 2014;30(5):557-62. PubMed PMID: 24296035.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved safety with intravenous insulin therapy for critically ill patients with renal failure. AU - Dickerson,Roland N, AU - Lynch,Allison M, AU - Maish,George O,3rd AU - Croce,Martin A, AU - Minard,Gayle, AU - Brown,Rex O, Y1 - 2013/10/22/ PY - 2013/05/13/received PY - 2013/09/27/revised PY - 2013/10/10/accepted PY - 2013/12/4/entrez PY - 2013/12/4/pubmed PY - 2014/12/15/medline KW - Acute kidney injury KW - Chronic kidney disease KW - Enteral nutrition KW - Hyperglycemia KW - Hypoglycemia KW - Parenteral nutrition KW - Regular human insulin KW - Trauma SP - 557 EP - 62 JF - Nutrition (Burbank, Los Angeles County, Calif.) JO - Nutrition VL - 30 IS - 5 N2 - OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of a new intravenous (IV) regular human insulin infusion (RHI) algorithm for glycemic control in critically ill patients with renal failure. METHODS: Adult trauma patients with renal failure who received a new RHI algorithm were compared with those who received the discontinued RHI algorithm (historical control). Target blood glucose (BG) concentration was 70 to 149 mg/dL (3.9-8.3 mmol/L). Patients were evaluated for 7 d while receiving the RHI infusion and continuous enteral or parenteral nutrition. RESULTS: Mean BG was higher for the new RHI algorithm group (n = 25) compared with control (n = 21): 145 ± 10 mg/dL or 8.1 ± 0.6 mmol/L versus 133 ± 14 mg/dL or 7.4 ± 0.8 mmol/L (P = 0.001). The new RHI algorithm resulted in less time within the target BG range (11.9 ± 2.5 h/d versus 16.1 ± 3.3 h/d; P = 0.001); however, BGs were within 70 to 179 mg/dL (or 3.9-10 mmol/L) for 16.3 ± 2.6 h/d. The proportion of patients who experienced an episode of moderate hypoglycemia (BG 40-60 mg/dL or 2.2-3.3 mmol/L) or severe hypoglycemia (BG < 40 mg/dL or 2.2 mmol/L) was decreased (32% versus 76%; P = 0.001) and eliminated (0% versus 29%, P = 0.006), respectively. CONCLUSIONS: The new RHI algorithm improved patient safety by decreasing the prevalence of moderate hypoglycemia and eliminating severe hypoglycemia. The duration of glycemic control within the target BG range was decreased, but acceptable within a higher target BG ceiling. SN - 1873-1244 UR - https://www.unboundmedicine.com/medline/citation/24296035/Improved_safety_with_intravenous_insulin_therapy_for_critically_ill_patients_with_renal_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0899-9007(13)00459-0 DB - PRIME DP - Unbound Medicine ER -