Does implementation of a computerised, decision-supported intensive insulin protocol achieve tight glycaemic control? A prospective observational study
KeywordsObservational Study Support Program Prospective Observational Study Mortality Reduction Significant Mortality
Implementation of an intensive insulin protocol, aiming for tight glycaemic control (TGC) (BG 4.4–6.1 mmol/l), has resulted in a significant mortality reduction from 8% with conventional treatment to 4.6% in the TGC group . An observational study suggests that a less stringent target BG range of 4–8 mmol/l may achieve mortality benefits .
To determine the degree to which TGC can be maintained using a TGC protocol.
At our general adult 22-bed ICU, we implemented a novel TGC protocol in mechanically ventilated patients aiming for a target glucose range of 4.4–6.1 mmol/l. The protocol was integrated on to the CIS by way of a decision support program. Ethics approval was gained. A prospective, observational study was carried out on 50 patients who were treated with the TGC protocol. All measured BG results were transferred and analysed to calculate the time spent in each predefined BG band. A linear trend was assumed between individual measurements.
Fifty consecutive patients were analyzed. This involved analysis of 7209 BG samples, over 9214 hours. The median time to reach glycaemic control was 10.4 ± 2.7 hours. The target TGC band (4.4–6.1 mmol/l) was achieved for a median of 23.1% of the time that patients were on TGC. For the majority of time (48.5%), BGs were within the band 6.2–7.99 mmol/l.
Use of the computerised decision-supported intensive insulin protocol did not achieve TGC for a prolonged percentage of each patient's stay, although it did deliver 'normoglycaemia' (4.4–7.99 mmol/l) for nearly three-quarters of the time. This observational examination of a 'real-life' situation reveals that TGC is difficult to achieve in critically ill patients.