Is normalized mean blood glucose level good enough for the intensive care unit?—Glycemic variability as a new independent predictor of mortality*

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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Insulin Sensitivity and Blood Glucose Level of Sepsis Patients in the Intensive Care Unit

2018 IEEE-EMBS Conference on Biomedical Engineering and Sciences (IECBES) ◽

10.1109/iecbes.2018.8626722 ◽

2018 ◽

Author(s):

Fatanah M. Suhaimi ◽

Ummu K. Jamaludin ◽

Normy N. A. Razak ◽

Mohd Basri Mat Nor ◽

Azrina M. Ralib ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Insulin Sensitivity ◽

Blood Glucose Level ◽

Glucose Level

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Nurse-Directed Blood Glucose Management in a Medical Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2017922 ◽

2017 ◽

Vol 37 (3) ◽

pp. 30-40 ◽

Cited By ~ 2

Author(s):

Friederike Compton ◽

Robert Ahlborn ◽

Torsten Weidehoff

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Glycemic Control ◽

Blood Glucose Level ◽

Glucose Level ◽

Nursing Workload ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Glucose Management

BACKGROUND Insulin-delivery algorithms for achieving glycemic control in the intensive care unit require frequent checks of blood glucose level and thus increase nursing workload. Hypoglycemia is a serious complication associated with intensive insulin therapy. OBJECTIVES To evaluate a nurse-directed protocol for blood glucose management that allows individualized insulin delivery within a predefined blood glucose corridor, intended to avoid hypoglycemia while maintaining adequate control of blood glucose level without increasing nursing workload. METHODS A nurse-directed protocol for blood glucose management was developed by an interprofessional team, and the protocol’s performance was investigated in 175 patients compared with 384 historical controls. RESULTS With the nurse-directed protocol, hypoglycemia incidents declined significantly (31% vs 12%, P < .001), and minimum blood glucose levels increased significantly (80 mg/dL vs 93 mg/dL, P < .001). Mean and maximum blood glucose levels, the proportion of glucose readings within the target range (31% vs 26%, P = .06), and the number of blood glucose checks (59 vs 58, P = .85) remained unchanged with use of the protocol. CONCLUSION Implementation of the nurse-directed protocol for blood glucose management did not increase nursing workload but reduced hypoglycemia incidents significantly while maintaining adequate glycemic control.

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The Impact of Preoperative Fasting Duration on Blood Glucose and Hemodynamics in Children

Journal of Diabetes Research ◽

10.1155/2020/6725152 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Pouran Hajian ◽

Minoo Shabani ◽

Elham Khanlarzadeh ◽

Mahshid Nikooseresht

Keyword(s):

Blood Pressure ◽

Blood Glucose ◽

Blood Glucose Level ◽

Systolic Blood Pressure ◽

Glucose Level ◽

Anesthesia Induction ◽

Preoperative Fasting ◽

Mean Blood Glucose ◽

Fasting Duration ◽

The Impact

Background. Prolonged preoperative fasting is one of the concerns of pediatricians and anesthesiologists in pediatric surgery. The aim of this study was to assess the impact of preoperative fasting duration on blood glucose and hemodynamics in children. Methods. This cross-sectional study was conducted on 50 children who were between the ages of 3 and 12 years in Besat Hospital, Hamedan, Iran. The time of the last solid and liquid meal taken by child were recorded based on interview with the parents. The first blood glucose test was obtained in the operation room, and the second test was performed 20 minutes after induction of anesthesia by glucometer. Systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR) were recorded before anesthesia induction and in five-minute intervals in the first 20 minutes of surgery. Results. The mean age of the children was 6.63 (SD 1.85) years. Mean blood glucose 20 minutes after surgery was 101.17 (SD 92) mg/dl, which was significantly higher than the baseline values (87.66 (SD 11.84) mg/dl) (P<0.001). The comparison of mean blood glucose level between groups of fasting with different duration for solids (<12 hours and >12 hours) and for liquids (<6 hours and >6 hours) revealed no significant difference in either groups (P>0.05). No significant correlation was observed between blood glucose level at the induction of anesthesia with weight and age (P>0.05). There was a significantly negative correlation between duration of fasting for liquids and SBP (P>0.05). Conclusion. Prolonged preoperative fasting cannot affect blood glucose in children; however, maybe it has impact on systolic blood pressure.

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Prospective analysis of glycemic variability in patients with severe traumatic brain injury: modified Leuven’s adjustment process versus conventional adjustment process

Journal of International Medical Research ◽

10.1177/0300060517738396 ◽

2018 ◽

Vol 46 (4) ◽

pp. 1505-1516

Author(s):

Bing Xue ◽

Shiyan Ruan ◽

Ping Xie ◽

Kaixuan Yan ◽

Zhi'e Gu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Blood Glucose ◽

Brain Injury ◽

Blood Glucose Level ◽

Glucose Level ◽

Severe Traumatic Brain Injury ◽

Early Stage ◽

Glycemic Variability ◽

Adjustment Process ◽

Significant Difference

Objective This study was performed to evaluate the effect of two different methods of controlling glycemic variability (GV) in patients with severe traumatic brain injury (STBI) undergoing surgery. Methods Patients with STBI were randomly grouped into a conventional adjustment process (CAP) group and modified Leuven’s adjustment process (mLAP) group. Each group included 50 patients. Blood glucose levels were continuously monitored and data were recorded and analyzed. Results The mean blood glucose level was stable in both groups for 5 days postoperatively with no significant difference. The standard deviation of the blood glucose level, mean amplitude of glycemic excursions, and glycemic lability index were significantly higher in the CAP than mLAP group for the first 2 days. In the final 3 days, no significant differences were observed between the two groups. The incidence of hypoglycemia was significantly higher in the CAP than mLAP group on the first day. This value gradually declined during the following 4 days, but the difference between the two groups was not significant. Conclusion The mLAP produced more favorable results than the CAP for GV control in the early stage after surgery for STBI.

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