Insulin therapy and blood glucose management in critically ill patients: a 1-day cross-sectional observational study in 69 French intensive care units

Maxime Desgrouas; Julien Demiselle; Laure Stiel; Vincent Brunot; Rémy Marnai; Sacha Sarfati; Maud Fiancette; Fabien Lambiotte; Arnaud W Thille; Maxime Leloup; Sébastien Clerc; Pascal Beuret; Anne-Astrid Bourion; Johan Daum; Rémi Malhomme; Ramin Ravan; Bertrand Sauneuf; Jean-Philippe Rigaud; Pierre-François Dequin; Thierry Boulain

doi:10.1186/s13613-023-01142-9

Insulin therapy and blood glucose management in critically ill patients: a 1-day cross-sectional observational study in 69 French intensive care units

Ann Intensive Care. 2023 Jun 17;13(1):53. doi: 10.1186/s13613-023-01142-9.

Authors

Maxime Desgrouas¹, Julien Demiselle^{2

3}, Laure Stiel^{4

5

6}, Vincent Brunot⁷, Rémy Marnai⁸, Sacha Sarfati⁹, Maud Fiancette¹⁰, Fabien Lambiotte¹¹, Arnaud W Thille¹², Maxime Leloup¹³, Sébastien Clerc¹⁴, Pascal Beuret¹⁵, Anne-Astrid Bourion¹⁶, Johan Daum¹⁷, Rémi Malhomme¹⁸, Ramin Ravan¹⁹, Bertrand Sauneuf²⁰, Jean-Philippe Rigaud²¹, Pierre-François Dequin^{22

23

24

25}, Thierry Boulain²⁶

Affiliations

¹ Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 45100, Orléans, France. maxime.desgrouas@orange.fr.
² Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
³ UMR 1260 Nanomedicine Regenerative, INSERM, Université de Strasbourg, Strasbourg, France.
⁴ Réanimation Médicale, Groupe Hospitalier de la Région Mulhouse Sud Alsace, Mulhouse, France.
⁵ UMR 1231, Inserm, LNC, Dijon, France.
⁶ LipSTIC, LabEx, Dijon, France.
⁷ Médecine Intensive Réanimation, Hôpital Universitaire Lapeyronie, Université de Montpellier, Montpellier, France.
⁸ Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Le Mans, 72000, Le Mans, France.
⁹ Medical Intensive Care Unit, Normandie Univ, UNIROUEN, UR 3830, CHU Rouen, 76000, Rouen, France.
¹⁰ Service de Médecine Intensive Réanimation, CHD Vendée la Roche Sur Yon, La Roche Sur Yon, France.
¹¹ Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France.
¹² CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
¹³ Service de Réanimation, Groupe Hospitalier La Rochelle Ré Aunis, La Rochelle, France.
¹⁴ Service de Médecine Intensive Et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France.
¹⁵ Réanimation Et Soins Continus, Centre Hospitalier de Roanne, Roanne, France.
¹⁶ Réanimation, Centre Hospitalier de Cholet, Cholet, France.
¹⁷ Médecine Intensive Réanimation, Centre Hospitalier Intercommunal Ballanger, Aulnay Sous Bois, France.
¹⁸ Service de Réanimation, Centre Hospitalier Antibes Juan-Les-Pins, Antibes, France.
¹⁹ Réanimation Polyvalente et Surveillance Continue, Centre Hospitalier de Vichy, Vichy, France.
²⁰ Médecine Intensive Réanimation, Centre Hospitalier Public du Cotentin, 50100, Cherbourg en Cotentin, France.
²¹ Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Avenue Pasteur, 76200, Dieppe, France.
²² Médecine Intensive - Réanimation, Hôpital Bretonneau, Tours, France.
²³ Centre d'Étude Des Pathologies Respiratoires, UMR 1100, INSERM, Université de Tours, Tours, France.
²⁴ INSERM CIC 1415, Tours, France.
²⁵ CRICS-TriGGERSep Network, Paris, France.
²⁶ Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 45100, Orléans, France.

Abstract

Background: Hyperglycaemia is common in critically ill patients, but blood glucose and insulin management may differ widely among intensive care units (ICUs). We aimed to describe insulin use practices and the resulting glycaemic control in French ICUs. We conducted a multicentre 1-day observational study on November 23, 2021, in 69 French ICUs. Adult patients hospitalized for an acute organ failure, severe infection or post-operative care were included. Data were recorded from midnight to 11:59 p.m. the day of the study by 4-h periods.

Results: Two ICUs declared to have no insulin protocol. There was a wide disparity in blood glucose targets between ICUs with 35 different target ranges recorded. In 893 included patients we collected 4823 blood glucose values whose distribution varied significantly across ICUs (P < 0.0001). We observed 1135 hyperglycaemias (> 1.8 g/L) in 402 (45.0%) patients, 35 hypoglycaemias (≤ 0.7 g/L) in 26 (2.9%) patients, and one instance of severe hypoglycaemia (≤ 0.4 g/L). Four hundred eight (45.7%) patients received either IV insulin (255 [62.5%]), subcutaneous (SC) insulin (126 [30.9%]), or both (27 [6.6%]). Among patients under protocolized intravenous (IV) insulin, 767/1681 (45.6%) of glycaemias were above the target range. Among patients receiving insulin, short- and long-acting SC insulin use were associated with higher counts of hyperglycaemias as assessed by multivariable negative binomial regression adjusted for the propensity to receive SC insulin: incidence rate ratio of 3.45 (95% confidence interval [CI] 2.97-4.00) (P < 0.0001) and 3.58 (95% CI 2.84-4.52) (P < 0.0001), respectively.

Conclusions: Practices regarding blood glucose management varied widely among French ICUs. Administration of short or long-acting SC insulin was not unusual and associated with more frequent hyperglycaemia. The protocolized insulin algorithms used failed to prevent hyperglycaemic events.

Keywords: Blood glucose; Critical care; Glycaemic control; Hyperglycaemia; Hypoglycaemia; Insulin.