Introduction
Strict glycemic control has been recommended for critically ill patients. However, its implementation may face difficulties with increased nursing workload, inadequate glucose control and higher risk of hypoglycemia.
Objective
We report the results of a randomized controlled trial to evaluate the efficacy and safety of three insulin algorithms in medical ICU (MICU) patients.
Methods
MICU patients with at least one blood glucose ≥150 mg/dl and who were on mechanical ventilation, or had SIRS, or were admitted because of trauma or burn were randomized to one of the following treatments: algorithm A – continuous insulin infusion with adjustments guided by a handheld device or desktop software targeting glucose levels between 100 and 130 mg/dl; algorithm B – continuous insulin aiming at glucose levels between 80 and 110 mg/dl; algorithm C – conventional treatment of intermittent subcutaneous administration of insulin if blood glucose levels exceeded 150 mg/dl. Efficacy was measured by the mean of patients' median blood glucose and safety was measured by the incidence of hypoglycemia (≤40 mg/dl).
Results
One hundred and nine patients were included. The APACHE II score was similar in the groups (20.5 ± 7.9). The efficacy and safety of the algorithms to attain glucose control are presented in Table 1.
Table 1.
| Algorithm A (n = 36) | Algorithm B (n = 36) | Algorithm C (n = 37) | P all groups | P A vs B | |
|---|---|---|---|---|---|
| Glucose median (mg/dl) | 124.8 | 128.5 | 161.3 | <0.001 | 0.45 |
| Hypoglycemia (n (%)) | 8 (22.2) | 17 (47.2) | 0 (0.0) | <0.001 | 0.03 |
| MICU death (n (%)) | 18 (51.4) | 19 (54.3) | 15 (40.5) | 0.47 | 0.81 |
Conclusion
A computer-guided insulin infusion protocol causes less episodes of hypoglycemia than, and is as efficacious as, the standard strict glycemic control protocol for controlling glucose at normal nonfasting levels (80–140 mg/dl) in MICU patients.