A comparison study of continuous insulin infusion protocols in the medical intensive care unit: Computer-guided vs. standard column-based algorithms
✍ Scribed by Christopher A. Newton; Dawn Smiley; Bruce W. Bode; Abbas E. Kitabchi; Paul C. Davidson; Sol Jacobs; R. Dennis Steed; Frankie Stentz; Limin Peng; Patrick Mulligan; Amado X. Freire; Angel Temponi; Guillermo E. Umpierrez
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 282 KB
- Volume
- 5
- Category
- Article
- ISSN
- 1553-5592
- DOI
- 10.1002/jhm.816
No coin nor oath required. For personal study only.
✦ Synopsis
To compare the safety and efficacy of continuous insulin infusion (CII) via a computer-guided and a standard paper form protocol in a medical intensive care unit (ICU).
METHODS:
Multicenter randomized trial of 153 ICU patients randomized to CII using the Glucommander (n ¼ 77) or a standard paper protocol (n ¼ 76). Both protocols used glulisine insulin and targeted blood glucose (BG) between 80 mg/dL and 120 mg/dL.
RESULTS:
The Glucommander resulted in a lower mean BG value (103 6 8.8 mg/dL vs. 117 6 16.5 mg/dL, P < 0.001) and in a shorter time to reach BG target (4.8 6 2.8 vs.7.8 hours 6 9.1 hours, P < 0.01), and once at target resulted in a higher percentage of BG readings within target (71.0 6 17.0% vs. 51.3 6 19.7%, P < 0.001) than the standard protocol. Mean insulin infusion rate in the Glucommander was similar to the standard protocol (P ¼ 0.12). The percentages of patients with !1 episode of BG <40 mg/dL and <60 mg/dL were 3.9% and 42.9% in the Glucommander and 5.6% and 31.9% in the standard, respectively [P ¼ not significant (NS)]. Repeated measures analyses show that the probabilities of BG reading <40 mg/dL or <60 mg/dL were not significantly different between groups (P ¼ 0.969, P ¼ 0.084) after accounting for within-patient correlations with or without adjusting for time effect. There were no differences between groups in the length of hospital stay (P ¼ 0.704), ICU stay (P ¼ 0.145), or inhospital mortality (P ¼ 0.561).
CONCLUSION: Both treatment algorithms resulted in significant improvement in glycemic control in critically ill patients in the medical ICU. The computer-based algorithm resulted in tighter glycemic control without an increased risk of hypoglycemic events compared to the standard paper protocol.