Related Experiment Video
Updated: May 17, 2026
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Clinical equipoise regarding glycemic control: a survey of pediatric intensivist perceptions
Eliotte L Hirshberg1, Katherine A Sward, Edward Vincent S Faustino
1Department of Pediatrics, University of Utah, Primary Children's Medical Center, Intermountain Medical Center, Murray, UT, USA. ellie.hirshberg@hsc.utah.edu
Insights
Pediatric intensivists are willing to join a blood glucose control trial. However, current practices and target ranges show significant variation, indicating a need for more research in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric critical care medicine
- Endocrinology
- Clinical trial research
Background:
- Blood glucose control in critically ill children is a complex issue with varying clinical practices.
- Previous surveys indicated a need to reassess pediatric intensivists' approaches and willingness to participate in trials.
- Adult data has not demonstrably influenced pediatric blood glucose management strategies.
Purpose of the Study:
- To evaluate pediatric intensivists' willingness to participate in a pediatric blood glucose control trial.
- To determine if adult-specific data has impacted self-reported practices in pediatric intensive care units (PICUs) over the last four years.
- To compare current practices with a previous 2005 survey.
Main Methods:
- A 30-item electronic questionnaire was distributed to North American pediatric intensivists.
- The survey targeted 96 institutions within the Pediatric Acute Lung Injury and Sepsis Network.
- A total of 209 pediatric intensivists participated, with a response rate of 68%.
Main Results:
- The preferred blood glucose target range shifted towards higher values (90-140 mg/dL in 2009 vs. 80-110 mg/dL in 2005).
- A significant decrease was observed in intensivists preferring a tighter glycemic control range (43% to 6%, p < 0.001).
- Despite practice variations, 93% of respondents expressed willingness to enroll patients in a pediatric blood glucose control trial.
Conclusions:
- Pediatric intensivists manage blood glucose in critically ill children but do not uniformly adopt adult data or a single target range.
- Current evidence does not fully address the concerns of pediatric intensive care unit clinicians.
- Persistent practice variations and unanswered questions highlight the necessity for a multicenter clinical trial on blood glucose control in critically ill children.
Objectives:
To assess the willingness of pediatric intensivists to conduct a pediatric trial of blood glucose control, and to determine if self-reported practices were influenced by adult-specific data over the past 4 yrs. This was a follow-up to our previous 2005 survey.
Design:
Electronic survey comprising a 30-item questionnaire.
Setting:
North American PICUs that were members of, or connected to, the Pediatric Acute Lung Injury and Sepsis Network (n = 96 targeted institutions).
Participants:
North American pediatric intensivists (n = 209).
Interventions:
None.
Methods:
We conducted a survey of North American PICUs using a Web-based questionnaire. Invitations were sent to 96 institutions in 37 states/provinces.
Results:
Response rate was 68% (141/209). The median definitions of hyperglycemia (150 mg/dL) and hypoglycemia (≤60 mg/dL) were similar to our 2005 survey results. Self-reported practice patterns remain variable. Although 75% of clinician respondents denied a change in clinical practice based on the published literature, the preferred blood glucose target range increased from 80-110 mg/dL in 2005 to 90-140 mg/dL in 2009. Intensivists who preferred a blood glucose target of 80-110 mg/dL decreased from 43% to 6% (p < 0.001). Many respondents (45%) indicated that the acceptable severe hypoglycemia rate (% patients) for a protocol was ≤2.5%. The majority (93%) indicated they would be willing to enroll patients in a pediatric trial of blood glucose control.
Conclusions:
Pediatric intensivists report that they control blood glucose with insulin in critically ill children and do not necessarily adopt adult-specific data or a single uniform blood glucose target. The published evidence does not adequately address PICU clinicians concerns. Unanswered questions and persistent variation in practice suggest a need for a multicenter clinical trial of blood glucose control in critically ill children.
Related Concept Videos
01:15Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
01:22Diabetes Mellitus: Type 2 and Gestational
01:25Diabetic Ketoacidosis l: Introduction
01:19Type I Diabetes III: Clinical Manifestations
01:16Insulin: Dosing Regimen and Adverse Effects
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:15Hypoglycemia and Glucagon