Skip to main content
  • Poster presentation
  • Open access
  • Published:

Enhanced insulin sensitivity variability in the first 3 days of ICU stay: implications for tight glycemic control


Effective tight glycemic control (TGC) can improve outcomes, particularly in cardiovascular surgery, but is difficult to achieve. Variability in insulin sensitivity/resistance resulting from the level and evolution of stress response, particularly early in a patient's stay, can lead to hyperglycemia and variability, which are associated with mortality. This study quantifies the daily evolution of the variability of insulin sensitivity for cardiovascular surgical and all other ICU patients.


Retrospective analysis of SPRINT TGC study data. Model-based insulin sensitivity (SI) was identified hourly from data. Hour-to-hour percentage changes in SI were assessed for cardiovascular surgical (CVS) patients (n = 76) and all other, noncardiovascular surgery (Non-CVS) patients (n = 317). Results are compared for days 1, 2, 3 and days 4 onward. Cumulative distribution functions (CDFs), median values, and interquartile points (25th and 75th percentiles) are used to assess differences between groups and their evolution over time.


CVS patients are more variable than Non-CVS patients on days 1 to 2 (P < 0.005) and similar on days 3 and 4 onward (P ≥ 0.13). Variability declines by day. CVS and Non-CVS patients are both more variable on each of days 1 to 3 than the overall day 4 onward values (P < 0.005). At the interquartile percentiles, CVS patients are 1.4 to 2.0 times more variable than Non-CVS patients on day 1, 1.40 to 1.44 times on day 2, and 1.1 to 1.2 times on day 3, but identical (< 1.1x difference) for day 4 onward. Absolute SI increases daily for both groups, and the difference between groups shrinks from 33% to 12% over days 1 to 3 and is 4% on day 4 onward (P < 0.005 for all). Glycemic control was equivalent for both groups (P > 0.05) and thus these results were not due to differences in TGC achieved, but patient-specific factors instead.


All ICU patients exhibit greater insulin sensitivity variability over days 1 to 3, and cardiovascular surgery patients are more variable than others. Clinically, the results imply that TGC patients, especially cardiovascular surgery patients, will require greater measurement frequency, reduced reliance on insulin, and more explicit specification of carbohydrate nutrition in days 1 to 3 to safely minimise glycemic variability and maximise control for best outcome.

Author information

Authors and Affiliations


Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Chase, J., Le Compte, A., Penning, S. et al. Enhanced insulin sensitivity variability in the first 3 days of ICU stay: implications for tight glycemic control. Crit Care 15 (Suppl 1), P388 (2011).

Download citation

  • Published:

  • DOI: