An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units

Background The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. Objectives To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. Methods Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. Results Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. Conclusions Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.

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Determination of favorable blood glucose target range for stochastic TARgeted (STAR) glycemic control in Malaysia

Indonesian Journal of Electrical Engineering and Computer Science ◽

10.11591/ijeecs.v15.i1.pp133-141 ◽

2019 ◽

Vol 15 (1) ◽

pp. 133

Author(s):

A. Abu-Samah ◽

N. N. A. Razak ◽

A. A. Razak ◽

U. K. Jamaludin ◽

F. M. Suhaimi ◽

...

Keyword(s):

Intensive Care ◽

Blood Glucose ◽

Glycemic Control ◽

Intensive Care Units ◽

Target Range ◽

Nursing Interventions ◽

Method Performance ◽

Scale Method ◽

Sliding Scale

Stress-induced hyperglycemia is common in critically ill patients, but there is uncertainty about what constitutes an optimal blood glucose target range for glycemic control. Furthermore, to reduce the rate of hyperglycemic and hypoglycemic events, model-based glycemic control protocols have been introduced, such as the stochastic targeted (STAR) glycemic control protocol. This protocol has been used in the intensive care units of Christchurch and Gyulà Hospital since 2010, and in Malaysia since 2017. In this study, we analyzed the adaptability of the protocol and identified the blood glucose target range most favorable for use in the Malaysian population. Virtual simulation results are presented for two clinical cohorts: one receiving treatment by the STAR protocol itself and the other receiving intensive insulin therapy by the sliding scale method. Performance and safety were analyzed using five clinical target ranges, and best control was simulated at a target range of 6.0–10.0 mmol/L. This target range had the best balance of performance, with the lowest risk of hypoglycemia and the lowest requirement for nursing interventions. The result is encouraging as the STAR protocol is suitable to provide better and safer glycemic control while using a target range that is already widely used in Malaysian intensive care units

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Blood Glucose Measurements in Arterial Blood of Intensive Care Unit Patients Submitted to Tight Glycemic Control: Agreement between Bedside Tests

Journal of Diabetes Science and Technology ◽

10.1177/193229680800200603 ◽

2008 ◽

Vol 2 (6) ◽

pp. 932-938 ◽

Cited By ~ 22

Author(s):

Dirk Van Vlasselaers ◽

Tom Herpe ◽

Ilse Milants ◽

Mona Eerdekens ◽

Pieter J. Wouters ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Glycemic Control ◽

Tight Glycemic Control ◽

Arterial Blood ◽

Bedside Tests

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778-P: The Impact of Self-Management Blood Glucose (SMBG) Real-Time Decision Support on Glycemic Control in Adult with T1D in China

Diabetes ◽

10.2337/db20-778-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 778-P

Author(s):

ZIYU LIU ◽

CHAOFAN WANG ◽

XUEYING ZHENG ◽

SIHUI LUO ◽

DAIZHI YANG ◽

...

Keyword(s):

Decision Support ◽

Blood Glucose ◽

Glycemic Control ◽

Real Time ◽

Self Management ◽

The Impact

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Characteristics of monitored diabetic patients by glycated haemoglobin (HbA1c)

International Journal of Bioassays ◽

10.21746/ijbio.2016.05.006 ◽

2016 ◽

Vol 5 (05) ◽

pp. 4563

Author(s):

Tariq A. Zafar

Keyword(s):

Blood Glucose ◽

Glycemic Control ◽

Glycated Haemoglobin ◽

Poor Glycemic Control ◽

Diabetic Patients ◽

Age Group ◽

Hba1c Test ◽

Significant Difference ◽

Tract Infections ◽

The Impact

Glycated haemoglobin (HbA1c) test indicates the blood glucose levels for the previous two to three months. Using HbA1c test may overcome many of the practical issues and prevent infections such as urinary tract infections (UTIs). The study aimed to evaluate the impact of glycemic control using HbA1c test to understand patient characteristics and UTIs prevalence. Glycemic control was evaluated by measuring HbA1c for a total of 208 diabetes patients who were regularly attending diabetes center in Al-Noor specialist hospital in Makkah. The results showed that good and moderate glycemic controlled patients were 14.9% and 16.9% respectively while the poor glycemic patients were 68.3%. Among the good improved glycemic control, 83.9% were females, 48.4% were from age group (15-44y). Among the moderately improved glycemic control, 68.4% were females, 54.3% were from age group (45-64 y) with no significant difference. The total number of the patients with positive UTIs was 55 (26.4%) while the total number of patients with negative was UTIs 153 (73.6%). Among the positive UTIs, 76.3% were with poor glycemic control while only 12.3% and 11% were moderate and good improved glycemic control respectively. Among the negative UTIs, 65.3% were with poor glycemic control while only 19% and 15.7% were with moderate and good improved glycemic control respectively. Prevalence of UTIs among diabetic patients was not significant (p > 0.05). It was concluded that HbA1c was useful monitoring tool for diabetes mellitus and may lead to improved outcomes. Using a HbA1c test may overcome many of the practical issues that affect the blood glucose tests.

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