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Published on: June 11, 2012
Improving blood sugar control during critical illness: a cohort study
Enda O'Connor1, David Tragen, Paul Fahey
1University of Queensland, Toowoomba Health Service District, Toowoomba, Qld 4350, Australia. endamed@yahoo.com.au
Journal of Critical Care
|March 31, 2009
Summary
Nurse-titrated glycemic control in intensive care units (ICUs) is safe and effective. This approach demonstrated better blood sugar control compared to traditional medical orders, with similar hypoglycemia rates.
Area of Science:
- Critical Care Medicine
- Endocrinology
Background:
- Effective glycemic control is crucial for critically ill patients.
- Intravenous insulin is commonly used in intensive care units (ICUs).
Purpose of the Study:
- To compare blood sugar control and safety between nurse-titrated and medically ordered glucose-insulin regimens.
- To evaluate the effectiveness of nurse-led glycemic management in a regional ICU.
Main Methods:
- Retrospective cohort study in a 9-bedded regional ICU in Queensland, Australia.
- Included 70 critically ill patients requiring intensive nursing and intravenous insulin.
- Compared a nursing group (nurse-determined insulin rates) with a medical group (traditional insulin sliding scale).
Main Results:
- 37 patients in the nursing group had 1949 glucose measurements; 33 in the medical group had 2118.
- Mean blood sugar levels were significantly lower in the nursing group (8.33 +/- 2.34 mmol/L) vs. medical group (8.78 +/- 2.74 mmol/L) (P < .001).
- Fewer glucose readings >10 mmol/L in the nursing group (18%) compared to the medical group (27%) (P = .038). Hypoglycemia incidence was similar.
Conclusions:
- Nurse-titrated glycemic control is safe and effective in a regional ICU setting.
- This approach leads to high compliance with glucose target ranges.
- Empowering ICU nurses in glycemic management improves patient outcomes.
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