Innovative Solutions: Development and Implementation of a Tight Blood Glucose Management Protocol

Introduction: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes, and the risk of mortality or significant morbidity is high among those who are treated in the intensive care unit (ICU) for more than 5 days. Objective: To assess the effect of glucose management protocol on mortality and morbidity in a heterogeneous population of critically ill adult patients. Design: A randomized controlled trial. Setting: A 24-bed medical-surgical intensive care unit (ICU) for adult patients at King Hussein Medical Center, the Royal Medical Services. Methods: A total of 50 patients who were considered to need intensive care for at least three days, were randomly assigned into two groups. The intervention group subjects were to undergo a glucose control protocol with insulin infusion titrated to maintain blood glucose level in a target range of 120-160 mg/dL; except septic patients, in whom the target was higher, 160- 180 mg/dL. Patients in the second group (control group) were treated by a conventional approach with reduction of blood glucose level only if the level was markedly elevated (>200 mg/dL) to maintain blood glucose level in a target range of 180-200 mg/dL. Results: After adjustment for baseline characteristics the 2 groups of patients were well matched, for age, sex, prevalence of diabetes mellitus, HbA1c value and distribution of diagnoses; the only significant difference was in the percentage of cardiovascular dysfunction, which was higher in the intervention group (p=0.047). After institution of the protocol, the mean blood glucose levels differed significantly between the two treatment groups during the study period (143.70±12.78 mg/dL in the intervention group versus 175.56±14.07 mg/dL in the control group (p<0.001). And patients in the intervention group received a larger mean insulin dose 28.32 ±16.38 units per day, vs. 14.60±12.26 in the control group (p=0.001). The difference in mortality between the two treatment groups was not significant at 28 days (p=0.370) and at 60 days (p=0.555). No significant increase in hypoglycemia episodes was reported in our blood glucose level target. Conclusion: The glucose management protocol resulted in significantly improved glycemic control and was not associated with increased rate of death or hypoglycemia.

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Implementation Of Intervention Program For Controlling Glucose Level Among ICU Patients

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n18p1 ◽

2016 ◽

Vol 12 (18) ◽

pp. 1

Author(s):

Hiyam Al-Haqeesh ◽

Shereen Ziad Alhuneity ◽

Laith A Obeidat ◽

Ali Sayel Al Rashaydah ◽

Jebril Ahmed Albedoor ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Intervention Group ◽

Target Range ◽

Control Group ◽

Management Protocol ◽

Glucose Management

Introduction: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes, and the risk of mortality or significant morbidity is high among those who are treated in the intensive care unit (ICU) for more than 5 days. Study objectives: To assess the effect of glucose management protocol on mortality and morbidity in a heterogeneous population of critically ill adult patients. Methods and materials: Study design: A randomized controlled trial. Study setting: Intensive care unit (ICU) for adult patients at King Hussein Medical Center, the Royal Medical Services. Study sample: A total of 50 patients were included in this study and assigned randomly into two groups, control group (N=25), and intervention group (N=25). Study protocol: The intervention group subjects were to undergo a glucose control protocol with insulin infusion titrated to maintain blood glucose level in a target range of 120-160 mg/dL; except septic patients, in whom the target was higher, 160- 180 mg/dL. Patients in the second group (control group) were treated by a conventional approach with reduction of blood glucose level only if the level was markedly elevated (>200 mg/dL) to maintain blood glucose level in a target range of 180-200 mg/dL Study findings: Although the difference in mortality between the two treatment groups was not significant at 28 days (p=0.370) and at 60 days (p=0.555), but it was to be considered for further improvements. No significant increase in hypoglycemia episodes was reported in our blood glucose level target. There was no significant difference in the development of new organ failure, new renal insufficiency, number of patients undergoing transfusion of packed red blood cells, use of antibiotics for more than 10 days, length of stay in the ICU and length of stay in the hospital. It was noticed that the rates of positive blood cultures were lower in the interventional group (8%) than in the control group (32), (p=0.068). Conclusion: The glucose management protocol resulted in significantly improved glycemic control and was not associated with increased rate of death or hypoglycemia.

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The effectiveness of active blood glucose management on the prevention of further CVA complications within 24 hours in adult patients: a systematic review

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-200402100-00001 ◽

2004 ◽

Vol 2 (10) ◽

pp. 1-14 ◽

Cited By ~ 1

Author(s):

Aye Aye Gyi

Keyword(s):

Systematic Review ◽

Blood Glucose ◽

Adult Patients ◽

Glucose Management

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Blood Glucose Management: the Over-Under

Journal of General Internal Medicine ◽

10.1007/s11606-021-06717-5 ◽

2021 ◽

Author(s):

Emilee Herringshaw

Keyword(s):

Blood Glucose ◽

Glucose Management

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Self-Care IoT Platform for Diabetic Mellitus

Applied Sciences ◽

10.3390/app11052006 ◽

2021 ◽

Vol 11 (5) ◽

pp. 2006

Author(s):

Jai-Chang Park ◽

Seongbeom Kim ◽

Je-Hoon Lee

Keyword(s):

Blood Glucose ◽

Self Care ◽

Target Range ◽

Process Data ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Iot Platform ◽

Number Of Patients ◽

Glucose Management ◽

The Relationship

Diabetes mellitus is a severe chronic disease, and the number of patients has increased. To manage blood glucose levels, patients should frequently measure their blood glucose and analyze which lifestyle habits affect blood glucose levels. However, it is hard to record and analyze the relationship between their blood glucose levels and lifestyle. The internet of things (IoT) is useful to interconnect, monitor, obtain, and process data between various devices used in everyday life to fulfill a common objective. This paper proposes an intelligent self-care platform using IoT technology that helps patients with chronic diabetes manage their blood glucose levels in their target range. In particular, we developed various devices called the self-care IoT pack. It consists of five different types of devices to obtain blood glucose levels, physical activities, food intake, medication, sleeping, and so on. They can collect blood glucose levels with lifestyles that automatically impact the patient’s blood glucose level. We also devised a self-care application to display and analyze the data obtained from the IoT pack. Consequently, the proposed self-care IoT platform collects the blood glucose levels and the lifestyles without any burden of record. By reviewing the accumulated information, the patients can find bad habits in blood glucose management and improve their lifestyle.

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