Computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose measurement is performed frequently and on time Export

@article{anorexic HDA, abstract = {INTRODUCTION:Control of blood glucose (BG) in critically ill patients is considered important, but is difficult to achieve, and often associated with increased risk of hypoglycemia. We examined the use of a computerized insulin dosing algorithm to manage hyperglycemia with particular attention to frequency and conditions surrounding hypoglycemic events. METHODS:This is a retrospective analysis of adult patients with hyperglycemia receiving intravenous (IV) insulin therapy from March 2006 to December 2007 in the intensive care units of 2 tertiary care teaching hospitals. Patients placed on a glycemic control protocol using the Clarian GlucoStabilizerTM IV insulin dosing calculator with a target range of 4.4-6.1 mmol/L were analyzed. Metrics included time to target, time in target, mean blood glucose +/- standard deviation, \% measures in hypoglycemic ranges <3.9 mmol/L, per-patient hypoglycemia, and blood glucose level testing interval. RESULTS:4,588 ICU patients were treated with the GlucoStabilizer to a BG target range of 4.4-6.1 mmol/L. We observed 254 severe hypoglycemia episodes (BG <2.2 mmol/L) in 195 patients, representing 0.1\% of all measurements, and in 4.25\% of patients or 0.6 episodes per 1000 hours on insulin infusion. The most common contributing cause for hypoglycemia was measurement delay (n=170, 66.9\%). The median (interquartile range) time to achieve the target range was 5.9 (3.8 - 8.9) hours. Nearly all (97.5\%) of patients achieved target and remained in target 73.4\% of the time. The mean BG (+/- SD) after achieving target was 5.4 (+/- .52) mmol/L. Targeted blood glucose levels were achieved at similar rates with low incidence of severe hypoglycemia in patients with and without diabetes, sepsis, renal, and cardiovascular disease.CONCLUSIONS:Glycemic control to a lower glucose target range can be achieved using a computerized insulin dosing protocol. With particular attention to timely measurement and adjustment of insulin doses, the risk of hypoglycemia experienced can be minimized.}, author = {Juneja, Rattan and Roudebush, Corbin and Nasraway, Stanley and Golas, Adam and Jacobi, Judith and Carroll, Joni and Nelson, Deborah and Abad, Victor and Flanders, Samuel}, citeulike-article-id = {5930104}, citeulike-linkout-0 = {http://dx.doi.org/10.1186/cc8129}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19822000}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19822000}, day = {12}, doi = {10.1186/cc8129}, issn = {1364-8535}, journal = {Critical Care}, keywords = {computerized, hospital, hypoglycemia, inpatient, intensive\_insulin}, month = {October}, number = {5}, pages = {R163+}, posted-at = {2009-10-23 18:50:14}, priority = {5}, title = {Computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose measurement is performed frequently and on time}, url = {http://dx.doi.org/10.1186/cc8129}, volume = {13}, year = {2009} }

TY - JOUR ID - anorexic HDA L3 - citeulike-article-id:5930104 N2 - INTRODUCTION:Control of blood glucose (BG) in critically ill patients is considered important, but is difficult to achieve, and often associated with increased risk of hypoglycemia. We examined the use of a computerized insulin dosing algorithm to manage hyperglycemia with particular attention to frequency and conditions surrounding hypoglycemic events. METHODS:This is a retrospective analysis of adult patients with hyperglycemia receiving intravenous (IV) insulin therapy from March 2006 to December 2007 in the intensive care units of 2 tertiary care teaching hospitals. Patients placed on a glycemic control protocol using the Clarian GlucoStabilizerTM IV insulin dosing calculator with a target range of 4.4-6.1 mmol/L were analyzed. Metrics included time to target, time in target, mean blood glucose +/- standard deviation, % measures in hypoglycemic ranges <3.9 mmol/L, per-patient hypoglycemia, and blood glucose level testing interval. RESULTS:4,588 ICU patients were treated with the GlucoStabilizer to a BG target range of 4.4-6.1 mmol/L. We observed 254 severe hypoglycemia episodes (BG <2.2 mmol/L) in 195 patients, representing 0.1% of all measurements, and in 4.25% of patients or 0.6 episodes per 1000 hours on insulin infusion. The most common contributing cause for hypoglycemia was measurement delay (n=170, 66.9%). The median (interquartile range) time to achieve the target range was 5.9 (3.8 - 8.9) hours. Nearly all (97.5%) of patients achieved target and remained in target 73.4% of the time. The mean BG (+/- SD) after achieving target was 5.4 (+/- .52) mmol/L. Targeted blood glucose levels were achieved at similar rates with low incidence of severe hypoglycemia in patients with and without diabetes, sepsis, renal, and cardiovascular disease.CONCLUSIONS:Glycemic control to a lower glucose target range can be achieved using a computerized insulin dosing protocol. With particular attention to timely measurement and adjustment of insulin doses, the risk of hypoglycemia experienced can be minimized. IS - 5 JF - Critical Care SN - 1364-8535 TI - Computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose measurement is performed frequently and on time VL - 13 SP - R163 KW - computerized KW - hospital KW - hypoglycemia KW - inpatient KW - intensive_insulin AU - Juneja, Rattan AU - Roudebush, Corbin AU - Nasraway, Stanley AU - Golas, Adam AU - Jacobi, Judith AU - Carroll, Joni AU - Nelson, Deborah AU - Abad, Victor AU - Flanders, Samuel PY - 2009/10/12/ UR - http://dx.doi.org/10.1186/cc8129 ER -