Results of an intensive insulin infusion protocol in diabetic and nondiabetic critically ill patients

Introduction

The implementation of an intensive insulin infusion protocol (IIIP) has recently been shown to improve results in the critically ill.

Methods

We retrospectively reviewed the clinical charts and specific nutritional records from the Nutrition Support Team of all the patients admitted to the ICU and submitted to an IIIP during 1 year (1 January–31 December 2004). On all patients we collected: demographics (age, sex), maximum SOFA score, clinical characteristics (diabetes mellitus, glucose levels above 130 mg/dl or below 60 mg/dl) and risk factors to hyperglycemia (drugs, infection).

Results

Over the study period, 37 patients received IIIP. All these patients presented infection and were submitted to mechanical ventilation. Twelve patients were diabetic and 25 were nondiabetic. A total of 10,239 glucose estimations were performed during 444 days. The demographics were well matched. The maximum SOFA score was bigger in the diabetic group (10 ± 2 vs 8 ± 3). We found 32% of hyperglycemic levels and 0.28% of hypoglycemia in the whole population. In the diabetic group, the incidence of hyperglycemia and hypoglycemia were, respectively, 37% and 0.44%, while in the nondiabetic group they were 29% and 0.21%.

Discussion

The literature provides similar trends in the safety profile of IIIP in the critically ill. It seems necessary to observe the differences between diabetic and nondiabetic patients.