Tight glucose control by intensive insulin therapy in Belgian ICU: an evaluation of practice

Introduction

Recent data suggest that a tight glucose control by intensive intensive therapy (TGCIIT) may improve survival of critically ill patients. The optimal target for blood glucose (BG), however, is a matter of debate and controversy, and the constraints associated with the implementation of TGCIIT are considerable.

Methods

The present study surveyed the current practice of glucose management. We sent a multiple-choice questionnaire to 120 Belgian ICUs, on behalf of the Belgian Federal Board for Intensive Care.

Results

Fifty-two ICUs (43%) answered. A total of 489 patients were staying in the ICUs when the questionnaire was filled. The number of glucometers per ICU bed averaged 0.6 ± 0.4 and the nurse/patient ratio averaged 0.6 ± 0.3. Glucose control is felt to be an important issue by all participants, while 96% are aware of the results of the landmark 2001 study of Van den Berghe and colleagues. Ninety percent changed their practice following this study. Fifty percent of the responders use TGCIIT for every patient, while others restricted TGCIIT to long-stayers, septic or diabetic patients. An algorithm is used for glucose control by 98% of the participants. The BG target is 80–110 mg/dl and 110–140 mg/dl for 27% and for 56% of the responders, respectively. BG is checked systematically two to eight times per day (five to eight times for 54%), on blood and capillary samples. Prior to the achievement of the target BG, checks are performed hourly (60%) or every 2 hours (28%). Once the target BG is reached, checks are performed six times (45%) to 12 times (36%) a day. The amount of glucose supplied per day ranged from 50 g to more than 200 g, with 55% of the participants providing 75–150 g. For 81% of the responders, patients are discharged from the ICU with subcutaneous insulin therapy. Finally, 98% of the responders are waiting for recommendations concerning TGCIIT.

Conclusion

In spite of an awareness of TGCIIT, the current practice is largely variable among ICUs. The need for practical recommendations, including the type of patients, the equipment required and the optimal BG target, is underlined by these data.