to evaluate the efficacy of intensive insulin protocol to control blood sugar in target of 4.4-6.1 mmol/l.
Data was abstracted from an ongoing randomized controlled trial in a 21–bedded medical surgical ICU at a tertiary center in Saudi Arabia. Patients were included if admission blood glucose was 6.1 mmol/l or higher.Patients were randomized to receive intensive insulin therapy (target blood glucose 4.4-6.1 mmol/l) or standard insulin therapy (target 10-11.1 mmol/l) using prewritten protocols. This study examines the efficacy of intensive insulin protocol in controlling blood glucose. We examined the time to achieve the target defined as the time (hours) needed to reach the upper limit of the target (6.1 mmol/l) for at least one reading. The number of blood sugar episodes above the target were also recorded (excluding the day of enrollment) and adjusted to the number of treatment days. We also recorded the number of hypoglycemic episodes (blood glucose below 2.2 mmol/l) and adjusted to the number of treatment days.
103 patients treated with intensive insulin therapy were analyzed. Patients were treated for a mean of 8.8 ± 6.7 days (range 1-33 days) and a total of 914 treatment days. The mean inclusion blood sugar was 10.7 ± 4.5 (range 6.1-27). The target blood glucose was reached in a mean of 6.7±3.3 hours. Average daily blood glucose levels are shown in the figure. There were a total of 7480 readings above the target averaging 8 /100 treatment days. There were a total of 138 hypoglycemic episodes averaging 15/100 treatment days.
Intensive insulin therapy protocol was effective in achieving the target level of 4.1-6.1 mmol/l in a relatively short time (6.7 hours) and for most of the treatment duration. This therapy was associated with the occurrence of hypoglycemia at a rate of 15/100 treatment days.
Physicians using intensive insulin therapy need to be aware of the frequency of complications; the impact of which can be minimized by at least hourly monitoring of blood glucose.
Ousama Dabbagh, one.