PURPOSE: Management of hyperglycemia in the critical care setting often involves complex and resource-intensive protocols. The hypothesis was that glycemic control could be achieved with a less complex and less labor intensive protocol that measured serum glucose every two-four hours instead of hourly.
METHODS: Our institution conducted a prospective pilot study involving 30 patients in the ICU and 684 glucose measurements. Primary endpoints included (1) time to target glucose of 140mg/dL, (2) number of glucose measures relapsing above 140mg/dL once target was achieved, and (3) the incidence of hypoglycemia (<=70mg/dL). These endpoints were compared with a historical control group. A secondary endpoint included nursing compliance with correct insulin dosing and glucose measurements.
RESULTS: A target glucose ≤140mg/dL was achieved in a mean of 4.2 hrs using the less complex and less labor intensive protocol compared with 6.0 hrs in the historical control group. Once target glucose was achieved 64.5% of the glucoses maintained within the goal range with the less labor intensive compared with 50% of the historical control group. Hypoglycemia (<=70mg/dL) occurred 1% in both groups. Correct insulin dose was performed 92% of the time and timing of glucose measurements was 98% with the less complex, less labor intensive protocol.
CONCLUSIONS: Glycemic control can be achieved using a less complex, less labor intensive protocol with a 2-4 hour glucose measurement compared with a 1-hour measurement. Patients on this less complex and less labor intensive protocol achieved target glucoses sooner, had fewer fluctuations in glucose values and had low hypoglycemia rates. Nursing compliance to the protocol was high.
CLINICAL IMPLICATIONS: Use of the less complex less labor intensive hyperglycemia protocol on a larger patient population is recommended and in place in our institution to ensure the continued efficacy of the protocol as well as limiting hypoglycemia.
DISCLOSURE: The following authors have nothing to disclose: Poome Chamnankit
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