Implementation of a tight glycaemic control protocol using a web-based insulin dose calculator

Area of Science:

• Critical Care Medicine
• Endocrinology
• Health Informatics

Background:

• Maintaining optimal blood glucose levels in intensive care units (ICUs) is crucial for patient outcomes.
• Traditional methods of glucose control can be challenging and may lead to suboptimal glycemic management.
• Web-based tools offer potential for standardizing and improving clinical decision-making in ICUs.

Purpose of the Study:

• To evaluate the effectiveness of a glucose control protocol supported by a web-based insulin dose calculator in an ICU setting.
• To assess the impact of protocol implementation and modification on blood glucose concentrations and patient mortality.
• To identify factors influencing glycemic control within the ICU environment.

Main Methods:

• Retrospective review of blood glucose concentrations in a 16-bedded ICU over three periods: pre-protocol, post-protocol introduction, and post-protocol modification.
• Utilized a web-based insulin dose calculator to support the glucose control protocol.
• Compared mean blood glucose levels and the proportion of glucose values within target ranges across the study periods.

Main Results:

• Mean blood glucose concentrations significantly decreased from 7.3 to 6.6, and then to 6.2 mmol/L after protocol implementation and modification.
• The proportion of glucose values below 8.0 mmol/L increased from 69% to 81%, and further to 89%.
• Intravenous nutrition and vasoactive drugs increased blood glucose, while propofol did not; patient mortality remained constant.

Conclusions:

• A glucose control protocol supported by a web-based insulin dose calculator effectively improved glycemic control in an ICU setting.
• The protocol demonstrated sustained improvement even after modification to increase insulin dosage.
• This approach offers a practical solution for enhancing glucose management outside of research environments.