Comparison of 2 intravenous insulin protocols: Glycemia variability in critically ill patients

Abstract

Objective: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability.

Material and methods: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively.

Results: Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001).

Conclusion: A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability.

Keywords: Control glucémico; Cuidados intensivos; Glycemic control; Glycemic variability; Hiperglucemia; Hyperglycemia; Insulin; Insulin protocol; Insulina; Intensive care; Protocolo insulina; Variabilidad glucémica.