1 Diabetes Care Unit, University Hospital of Caen , Caen, France .
2 Biostatistic Unit, University Hospital of Caen , Caen, France .
Diabetes Technol Ther. 2017 Feb;19(2):115-123. doi: 10.1089/dia.2016.0314.
Stress-induced hyperglycemia is a common feature of intensive care unit (ICU) patients. Besides mean blood glucose (BG) level, glucose variability and hypoglycemia have been highlighted as independent predictors of ICU and hospital mortality. Recent ICU recommendations suggest using insulin infusion protocols that can minimize glucose variability and hypoglycemic risk. Our aim was to assess the efficacy, safety, and acceptance by nurses of a paper-based simple dynamic insulin protocol compared with those by nurses of a paper-based static protocol.
This is a 1 year stepped-wedge study that compared a static sliding scale protocol (SP - static protocol) with a validated dynamic paper-based intravenous insulin infusion protocol (DP - dynamic protocol) in medical ICU patients of a single university hospital. Patients with stress-induced hyperglycemia >9.9 mmol/L and ≥48 h intravenous insulin infusion were included in this trial.
One hundred thirty-one patients were included and received continuous intravenous insulin infusion managed with SP (n = 65) or DP (n = 66). Glucose variability was significantly higher in the SP group than in the DP group (mean average glucose excursion index: 0.90 [0.00-1.91] mmol/L vs. 0.00 [0.00-0.90] mmol/L, respectively; P = 0.001). The percentage of time spent in the target range (7.7-9.9 mmol/L) was lower in the SP group than in the DP group (42.5% [28.8%-54.2%] vs. 47.5% [36.6%-57.1%]; P = 0.037). Low BG (<4.4 mmol/L) and hypoglycemia (<3.3 mmol/L) were more frequent in the SP group than in the DP group. According to a satisfaction survey, this protocol was well accepted by nurses.
Our simple and feasible paper-based, dynamic insulin infusion protocol reduced glycemic variability and hypoglycemic risk in a medical ICU.
应激性高血糖是重症监护病房（ICU）患者的常见特征。除了平均血糖（BG）水平外，血糖变异性和低血糖已被强调为 ICU 和医院死亡率的独立预测因素。最近的 ICU 建议使用可以最大程度降低血糖变异性和低血糖风险的胰岛素输注方案。我们的目的是评估一种基于纸张的简单动态胰岛素方案相对于基于纸张的静态方案的有效性、安全性和护士接受程度。
这是一项为期 1 年的逐步楔形研究，比较了一所大学附属医院的医疗 ICU 患者中使用的静态滑动量表方案（SP-静态方案）与经过验证的基于纸张的动态静脉内胰岛素输注方案（DP-动态方案）。本试验纳入了应激性高血糖>9.9mmol/L 且接受静脉内胰岛素输注>48h 的患者。
共纳入 131 例患者，连续接受 SP（n=65）或 DP（n=66）管理的静脉内胰岛素输注。SP 组的血糖变异性明显高于 DP 组（平均平均血糖波动指数：0.90[0.00-1.91]mmol/L 比 0.00[0.00-0.90]mmol/L，P=0.001）。SP 组目标范围内（7.7-9.9mmol/L）的时间百分比低于 DP 组（42.5%[28.8%-54.2%]比 47.5%[36.6%-57.1%]，P=0.037）。SP 组低血糖（<4.4mmol/L）和低血糖症（<3.3mmol/L）的发生率高于 DP 组。根据满意度调查，该方案得到了护士的认可。
我们简单可行的基于纸张的动态胰岛素输注方案降低了医疗 ICU 中的血糖变异性和低血糖风险。
