Management of diabetes mellitus and hospital-related hyperglycemia in patients of a medical ICU, results of a prospective study

Objective: Optimal control of blood glucose in the ICU has been shown to significantly decrease mortality and morbidity of severely ill patients. The purpose of the present project was to enable sufficient glucose control in critically ill patients, in the setting of a city hospital ICU with limited personnel and facilities.

Research design and methods: From January 2003 to January 2006, a total of 745 patients (3197 patient-days) were treated for hyperglycemia in our medical ICU. On July 2003 two different intensive insulin therapy protocols were implemented: A protocol of continuous intravenous insulin was used for patients with compromised peripheral tissue perfusion, while a protocol of subcutaneous intensive insulin therapy was adopted for patients with stable circulation. 134 patients were treated during the run-in phase of the project and 539 patients were treated during the main treatment phase. 72 patients treated for hyperglycemia in our ICU prior to the implementation of the two protocols (from January 2003 to July 2003) served as controls.

Results: After the implementation of the two protocols, a marked overall increase of normoglycemic blood glucose values (64.65% vs. 48.49%, P<0.001), a decrease of manifest hyperglycemias (6.39% vs. 17.42%, P<0.001) and a slight increase in hypoglycemic events (1.75% vs. 0.69%, P<0.001) was observed. Seven cases of severe hypoglycemia requiring glucose infusion were observed during the main treatment phase (0.3%). No hypoglycemia-associated deaths occurred.

Conclusions: The combined implementation of the two protocols presents a simple, safe and effective way of pursuing normoglycemia in critically ill patients.