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Impact of a Paper-Based Dynamic Insulin Infusion Protocol on Glycemic Variability, Time in Target, and Hypoglycemic Risk: A Stepped Wedge Trial in Medical Intensive Care Unit Patients.
Diabetes Technol Ther. 2017 02; 19(2):115-123.DT

Abstract

BACKGROUND

Stress-induced hyperglycemia is a common feature of intensive care unit (ICU) patients. Besides mean blood glucose (BG) level, glucose variability and hypoglycemia have been highlighted as independent predictors of ICU and hospital mortality. Recent ICU recommendations suggest using insulin infusion protocols that can minimize glucose variability and hypoglycemic risk. Our aim was to assess the efficacy, safety, and acceptance by nurses of a paper-based simple dynamic insulin protocol compared with those by nurses of a paper-based static protocol.

METHODS

This is a 1 year stepped-wedge study that compared a static sliding scale protocol (SP - static protocol) with a validated dynamic paper-based intravenous insulin infusion protocol (DP - dynamic protocol) in medical ICU patients of a single university hospital. Patients with stress-induced hyperglycemia >9.9 mmol/L and ≥48 h intravenous insulin infusion were included in this trial.

RESULTS

One hundred thirty-one patients were included and received continuous intravenous insulin infusion managed with SP (n = 65) or DP (n = 66). Glucose variability was significantly higher in the SP group than in the DP group (mean average glucose excursion index: 0.90 [0.00-1.91] mmol/L vs. 0.00 [0.00-0.90] mmol/L, respectively; P = 0.001). The percentage of time spent in the target range (7.7-9.9 mmol/L) was lower in the SP group than in the DP group (42.5% [28.8%-54.2%] vs. 47.5% [36.6%-57.1%]; P = 0.037). Low BG (<4.4 mmol/L) and hypoglycemia (<3.3 mmol/L) were more frequent in the SP group than in the DP group. According to a satisfaction survey, this protocol was well accepted by nurses.

CONCLUSIONS

Our simple and feasible paper-based, dynamic insulin infusion protocol reduced glycemic variability and hypoglycemic risk in a medical ICU.

Authors+Show Affiliations

1 Diabetes Care Unit, University Hospital of Caen , Caen, France .2 Biostatistic Unit, University Hospital of Caen , Caen, France .1 Diabetes Care Unit, University Hospital of Caen , Caen, France .3 Intensive Care Unit, University Hospital of Caen , Caen, France .3 Intensive Care Unit, University Hospital of Caen , Caen, France .3 Intensive Care Unit, University Hospital of Caen , Caen, France .3 Intensive Care Unit, University Hospital of Caen , Caen, France .1 Diabetes Care Unit, University Hospital of Caen , Caen, France .

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28118045

Citation

Clergeau, Antoine, et al. "Impact of a Paper-Based Dynamic Insulin Infusion Protocol On Glycemic Variability, Time in Target, and Hypoglycemic Risk: a Stepped Wedge Trial in Medical Intensive Care Unit Patients." Diabetes Technology & Therapeutics, vol. 19, no. 2, 2017, pp. 115-123.
Clergeau A, Parienti JJ, Reznik Y, et al. Impact of a Paper-Based Dynamic Insulin Infusion Protocol on Glycemic Variability, Time in Target, and Hypoglycemic Risk: A Stepped Wedge Trial in Medical Intensive Care Unit Patients. Diabetes Technol Ther. 2017;19(2):115-123.
Clergeau, A., Parienti, J. J., Reznik, Y., Clergeau, D., Seguin, A., Valette, X., du Cheyron, D., & Joubert, M. (2017). Impact of a Paper-Based Dynamic Insulin Infusion Protocol on Glycemic Variability, Time in Target, and Hypoglycemic Risk: A Stepped Wedge Trial in Medical Intensive Care Unit Patients. Diabetes Technology & Therapeutics, 19(2), 115-123. https://doi.org/10.1089/dia.2016.0314
Clergeau A, et al. Impact of a Paper-Based Dynamic Insulin Infusion Protocol On Glycemic Variability, Time in Target, and Hypoglycemic Risk: a Stepped Wedge Trial in Medical Intensive Care Unit Patients. Diabetes Technol Ther. 2017;19(2):115-123. PubMed PMID: 28118045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of a Paper-Based Dynamic Insulin Infusion Protocol on Glycemic Variability, Time in Target, and Hypoglycemic Risk: A Stepped Wedge Trial in Medical Intensive Care Unit Patients. AU - Clergeau,Antoine, AU - Parienti,Jean-Jacques, AU - Reznik,Yves, AU - Clergeau,Deborah, AU - Seguin,Amelie, AU - Valette,Xavier, AU - du Cheyron,Damien, AU - Joubert,Michael, PY - 2017/1/25/entrez PY - 2017/1/25/pubmed PY - 2017/11/4/medline KW - Dynamic insulin infusion protocol KW - Glycemic variability KW - Hypoglycemia KW - Intensive care unit KW - Nurse care KW - Stress hyperglycemia SP - 115 EP - 123 JF - Diabetes technology & therapeutics JO - Diabetes Technol Ther VL - 19 IS - 2 N2 - BACKGROUND: Stress-induced hyperglycemia is a common feature of intensive care unit (ICU) patients. Besides mean blood glucose (BG) level, glucose variability and hypoglycemia have been highlighted as independent predictors of ICU and hospital mortality. Recent ICU recommendations suggest using insulin infusion protocols that can minimize glucose variability and hypoglycemic risk. Our aim was to assess the efficacy, safety, and acceptance by nurses of a paper-based simple dynamic insulin protocol compared with those by nurses of a paper-based static protocol. METHODS: This is a 1 year stepped-wedge study that compared a static sliding scale protocol (SP - static protocol) with a validated dynamic paper-based intravenous insulin infusion protocol (DP - dynamic protocol) in medical ICU patients of a single university hospital. Patients with stress-induced hyperglycemia >9.9 mmol/L and ≥48 h intravenous insulin infusion were included in this trial. RESULTS: One hundred thirty-one patients were included and received continuous intravenous insulin infusion managed with SP (n = 65) or DP (n = 66). Glucose variability was significantly higher in the SP group than in the DP group (mean average glucose excursion index: 0.90 [0.00-1.91] mmol/L vs. 0.00 [0.00-0.90] mmol/L, respectively; P = 0.001). The percentage of time spent in the target range (7.7-9.9 mmol/L) was lower in the SP group than in the DP group (42.5% [28.8%-54.2%] vs. 47.5% [36.6%-57.1%]; P = 0.037). Low BG (<4.4 mmol/L) and hypoglycemia (<3.3 mmol/L) were more frequent in the SP group than in the DP group. According to a satisfaction survey, this protocol was well accepted by nurses. CONCLUSIONS: Our simple and feasible paper-based, dynamic insulin infusion protocol reduced glycemic variability and hypoglycemic risk in a medical ICU. SN - 1557-8593 UR - https://www.unboundmedicine.com/medline/citation/28118045/Impact_of_a_Paper_Based_Dynamic_Insulin_Infusion_Protocol_on_Glycemic_Variability_Time_in_Target_and_Hypoglycemic_Risk:_A_Stepped_Wedge_Trial_in_Medical_Intensive_Care_Unit_Patients_ L2 - https://www.liebertpub.com/doi/10.1089/dia.2016.0314?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -