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Critical Care

, 9:P388 | Cite as

Tight glycemic control increases the incidence of hypoglycemia in intensive care unit patients

  • H Moeniralam
  • P Spronk
  • M Graat
  • M Vroom
  • J Rommes
  • M Schultz
Poster presentation

Keywords

Blood Glucose Level Hypoglycemia Intensive Care Unit Patient Severe Hypoglycemia Hospital Information System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Introduction

Hyperglycemia is common in critically ill patients. Tight glycemic control (aimed at blood glucose levels of 4.4–6.1 mmol/l) improved the mortality and morbidity in postoperative intensive care patients [1]. Tight glycemic control, however, bares the risk of hypoglycemia. The present study was performed to investigate whether the introduction of a nurse-driven tight glycemic control protocol in two general ICUs increases the incidence of (severe) hypoglycemia.

Methods

All measured plasma glucose levels in all patients admitted to a 28-bed academic ICU and to a 10-bed ICU of an affiliated teaching hospital from 1999 to 2003 were retrospectively collected from the hospital information systems. Severe hypoglycemia was defined as blood glucose levels < 2.2 mmol/l, and hypoglycemia as blood glucose levels < 4.4 mmol/l. Comparisons were made between the period before (1999–2001) and after (2002–2003) implementation of tight glycemic control. Directly after analysis of the aforementioned study results, an adjusted tight glucose protocol was implemented in daily ICU practice at the end of 2001.

Statistics

Data are means ± standard deviation. Comparisons between years were made by chi-square test. Statistical significance was accepted for P < 0.05.

Results

For all years, > 99% of data were retrieved in both centres. In the AMC approximately 220,000 blood glucose levels were collected (1999–2002: 3869 patients, 2002–2003: 2613 patients); in the GH approximately 35,000 blood glucose levels were collected (1999–2001: 1639 patients, 2002–2003: 1098 patients).

Conclusions

Tight glycemic control dramatically raises the incidence of hypoglycemia. In parallel the incidence of severe hypoglycemia also increases. Better glucose control regimens are therefore needed to reduce the incidence of hypoglycemia during tight glycemic control.
Table 1

Mean blood glucose values (mmol/l) and percentage of patients developing (severe) hypoglycemia

Hospital

1999

2000

2001

2002

2003

Mean blood glucose

AMC

9.2 ± 3.2

9.0 ± 3.2

8.8 ± 3.0

7.8 ± 2.5*

7.4 ± 2.5*

GH

9.0 ± 3.6

9.2 ± 5.4

9.2 ± 4.8

8.8 ± 4.1*

8.5 ± 3.5*

% of patients with glucose < 2.2 mmol/l

AMC

0.6

2.1

1.9

3.6*

5.1*

GH

1.4

1.0

0.7

1.6*

2.2*

% of patients with glucose < 4.4 mmol/l

AMC

13.4

13.1

15.8

30.0*

38.8*

GH

12.4

12.0

11.4

17.3*

17.1*

* P < 0.05 compared with the period before tight glycemic control.

References

  1. 1.
    van den Berghe G, et al.: N Engl J Med. 2001, 345: 1359-1367. 10.1056/NEJMoa011300PubMedCrossRefGoogle Scholar

Copyright information

© BioMed Central Ltd 2005

Authors and Affiliations

  • H Moeniralam
    • 1
  • P Spronk
    • 2
  • M Graat
    • 1
  • M Vroom
    • 1
  • J Rommes
    • 2
  • M Schultz
    • 1
  1. 1.Academic Medical CenterAmsterdamNetherlands
  2. 2.Gelre HospitalApeldoornNetherlands

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