Glycemic control in the ICU: a multicenter survey

Area of Science:

• Critical Care Medicine
• Endocrinology
• Clinical Nursing

Background:

• Intensive insulin therapy has demonstrated benefits in reducing morbidity and mortality in critically ill patients.
• Understanding clinician perspectives is crucial for optimizing glycemic control strategies.

Purpose of the Study:

• To investigate the beliefs and attitudes of intensive care unit (ICU) clinicians regarding glycemic control targets.
• To identify potential discrepancies in threshold perceptions between nurses and physicians.

Main Methods:

• A self-administered survey was distributed to ICU nurses and physicians across five university-affiliated multidisciplinary ICUs.
• Data were collected on perceived clinically important thresholds for hypoglycemia and hyperglycemia.

Main Results:

• Nurses reported significantly higher thresholds for hyperglycemia compared to physicians in both diabetic and non-diabetic patients.
• Avoidance of hyperglycemia was prioritized for patients with acute brain injury, recent seizures, advanced liver disease, and acute myocardial infarction.
• A significant proportion of clinicians expressed concerns regarding the accuracy of glucometer measurements in critically ill patients.

Conclusions:

• Clinician beliefs and attitudes significantly influence glycemic control practices in the ICU.
• Tailored educational and clinical strategies are needed to align clinician behavior with evidence-based glycemic management.
• Future research should address concerns about glucometer accuracy to enhance treatment efficacy.