Hypoglycemia Reduction Strategies in the ICU

Braithwaite, Susan S.; Bavda, Dharmesh B.; Idrees, Thaer; Qureshi, Faisal; Soetan, Oluwakemi T.

doi:10.1007/s11892-017-0963-3

Cited by 5 publications

(4 citation statements)

References 105 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A target blood glucose concentration of 144 to 180 mg/dL (8.0 to 10.0 mmol/L) is likely to reduce the risk of hypoglycemia in critically ill patients [ 19 ], and glucose concentrations above 180 mg/dL (10.0 mmol/L) have been linked to increased mortality in people with COVID-19 [ 20 ]. Clinically significant hypoglycemia has been defined as < 54 mg/dL (3.0 mmol/L), whereas a glucose alert value is defined as ≤ 70 mg/dL (3.9 mmol/L) [ 21 ]. The protocol set the target blood glucose levels at 101–160 mg/dL, and there were almost no instances of significant hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

A continuous intravenous insulin infusion protocol to manage high-dose methylprednisolone-induced hyperglycemia in patients with severe COVID-19

Takahashi¹,

Matsuura²,

Domi³

et al. 2022

Clin Diabetes Endocrinol

View full text Add to dashboard Cite

Background Many patients with severe COVID-19 have impaired glucose tolerance, and steroid therapy is a standard treatment. Thus, good glycemic control is important and correlates with better patient outcomes. We began using a continuous intravenous insulin infusion protocol for glycemic control whose infusion rate changes based on the currently measured value and previous value. This study aimed to evaluate this protocol for COVID-19 patients requiring mechanical ventilation. Methods This single-center, retrospective, case control study was conducted on all adult patients who required mechanical ventilation for severe COVID-19 pneumonia admitted to our critical care center from April 1, 2020 through June 20, 2021. Blood glucose levels were measured in all patients every 4 h after admission. We started using the insulin infusion protocol from August 1, 2020. Patients before starting the protocol comprised the non-protocol group and those after starting the protocol comprised the protocol group. Blood glucose levels and hypo- or hyperglycemia events were compared between groups. We also surveyed ICU nurses about their experience using the protocol. Results During the study period, 173 patients with COVID-19 were admitted. After 15 patients were excluded for several reasons, the study included 158 patients: non-protocol group (n = 14) and protocol group (n = 144). In the initial phase (days 1–2), blood glucose levels of the protocol group were higher compared with the non-protocol group, and as the number of measurements increased, blood glucose levels were gradually brought under control within the target range in the protocol group. Almost no hypoglycemic events (blood glucose < 80 mg/dL) were detected in either group. The rate of hyperglycemia (blood glucose > 300 mg/dL) was about 5–10% in the initial phase in the protocol group and about 10–15% in the early phase (days 3–4) in the non-protocol group. The questionnaire survey revealed that 80% of ICU nurses responded favorably. Conclusions This insulin protocol gradually brought the blood glucose level within target levels in severe COVID-19 patients treated with high-dose steroid. Some hyperglycemia events were detected despite patients being under the protocol in the initial phase, and thus, minor modifications of the protocol might be required in the initial phase.

show abstract

Section: Discussionmentioning

confidence: 99%

A continuous intravenous insulin infusion protocol to manage high-dose methylprednisolone-induced hyperglycemia in patients with severe COVID-19

Takahashi¹,

Matsuura²,

Domi³

et al. 2022

Clin Diabetes Endocrinol

View full text Add to dashboard Cite

show abstract

“…It generally occurs more often in patients with higher HbA1C [ 35 ] or high glycemic variations [ 36 ] and even more frequently in studies using tight glycemic controls [ 28 ]. In studies dealing with glycemic control, hypoglycemia is reported to be between 4.8 and 54% depending on the definitions of blood glucose target and hypoglycemia [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial

et al. 2022

View full text Add to dashboard Cite

Background Stress hyperglycemia can persist during an intensive care unit (ICU) stay and result in prolonged requirement for insulin (PRI). The impact of PRI on ICU patient outcomes is not known. We evaluated the relationship between PRI and Day 90 mortality in ICU patients without previous diabetic treatments. Methods This is a post hoc analysis of the CONTROLING trial, involving 12 French ICUs. Patients in the personalized glucose control arm with an ICU length of stay ≥ 5 days and who had never previously received diabetic treatments (oral drugs or insulin) were included. Personalized blood glucose targets were estimated on their preadmission usual glycemia as estimated by their glycated A1c hemoglobin (HbA1C). PRI was defined by insulin requirement. The relationship between PRI on Day 5 and 90-day mortality was assessed by Cox survival models with inverse probability of treatment weighting (IPTW). Glycemic control was defined as at least one blood glucose value below the blood glucose target value on Day 5. Results A total of 476 patients were included, of whom 62.4% were male, with a median age of 66 (54–76) years. Median values for SAPS II and HbA1C were 50 (37.5–64) and 5.7 (5.4–6.1)%, respectively. PRI was observed in 364/476 (72.5%) patients on Day 5. 90-day mortality was 23.1% in the whole cohort, 25.3% in the PRI group and 16.1% in the non-PRI group (p < 0.01). IPTW analysis showed that PRI on Day 5 was not associated with Day 90 mortality (IPTWHR = 1.22; CI 95% 0.84–1.75; p = 0.29), whereas PRI without glycemic control was associated with an increased risk of death at Day 90 (IPTWHR = 3.34; CI 95% 1.26–8.83; p < 0.01). Conclusion In ICU patients without previous diabetic treatments, only PRI without glycemic control on Day 5 was associated with an increased risk of death. Additional studies are required to determine the factors contributing to these results.

show abstract

“…Validated algorithms for the titration of insulin infusion are essential to minimize adverse events, hypoglycemia, and glucose variability. Hypoglycemia prevention, recognition and treatment algorithm should be included in the insulin titration protocol[ 46 ]. The protocols should be descriptive with intervals for glucose checks, device used, sampling site etc.…”

Section: Management Of Hyperglycemia In the Icumentioning

confidence: 99%

Clinical challenges of glycemic control in the intensive care unit: A narrative review

Sreedharan¹,

Martini²,

Das³

et al. 2022

World J Clin Cases

View full text Add to dashboard Cite

Glucose control in patient admitted to the intensive care unit has been a topic of much debate over the past 20 years. The harmful effects of uncontrolled hyperglycemia and hypoglycemia in critically ill patients is well established. Although a large clinical trial in 2001 demonstrated significant mortality and morbidity benefits with tight glucose control in this patient population, the results could not be replicated by other investigators. The “Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation” trial in 2009 established that tight glucose control was not only of no benefit, but in fact harmful due to the significant risk of hypoglycemia. The current guidelines suggest a moderate approach with the initiation of intravenous insulin therapy in critically ill patients when the blood glucose level is above 180 mg/dL. The most important factor that underpins glycemic management in intensive care unit patients is the consequent prevention of hypoglycemia. Robust glucose monitoring strategies and insulin protocols need to be implemented in order to achieve this goal.

show abstract

Hypoglycemia Reduction Strategies in the ICU

Cited by 5 publications

References 105 publications

A continuous intravenous insulin infusion protocol to manage high-dose methylprednisolone-induced hyperglycemia in patients with severe COVID-19

A continuous intravenous insulin infusion protocol to manage high-dose methylprednisolone-induced hyperglycemia in patients with severe COVID-19

Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial

Clinical challenges of glycemic control in the intensive care unit: A narrative review

Contact Info

Product

Resources

About