Table 4 Summary of several insulin infusion protocols in different ICU settings
Authors | ICU type | Study | n | % Diabetic patients | Protocol | Target glycemia (mg/dl) | Method of glucose measurements |
|---|---|---|---|---|---|---|---|
Goldberg et al. (2004) | MICU | Observational | 52 | 56 | Yale | 100–139 | Hospital glucose meter: near hourly measurements |
Van den Berghe et al. (2006) | MICU | RCT | 1200 | 17 | Paper: Leuven | 80–110 | ABG: q1-4 h |
Kulnik et al. (2008) | MICU | Observational | 10 | 20 | eMPC (computer) | 80–110 | Variable sampling rate: q20 min-4 h |
Shetty et al. (2012) | MICU | Observational | 90 | 66 | Yale | 120–160 | POC meter: hourly measurements |
Holzinger et al. (2010) | MICU | RCT | 124 | 19 | Leuven | 80–110 | CGM |
De Block et al. (2015) | MICU | RCT | 35 | 23 | Yale | 80–110 | CGM |
Finney et al. (2003) | Mixed | Observational | 523 | 16 | Paper | 90–145 | ABG |
Juneja et al. (2007) | Mixed | Observational | 2398 | NR | Clarian Gluco Stabilizer | 80–110 | POC: q1-2 h |
Chase et al. (2008) | Mixed | Observational | 371 | 17 | SPRINT | 80–110 | Sampling rate: q1-2 h |
Morris et al. (2008) | Mixed | Before–after | 755 | NR | eProtocol-insulin versus paper | 80–110 | POC: q1-4 h |
Preiser et al. GLUCONTROL (2009) | Mixed | RCT | 1078 | 21 | Paper: glucontrol | 80–110 | POC: q1-4 h |
NICE SUGAR (2009) | Mixed | RCT | 6104 | 20 | Paper: Leuven | 81–108 | ABG |
Marvin et al. (2013) | Mixed | Retrospective | 1657 | NR | Computerized Yale | 100–140 | POC: variable time interval |
Van Herpe et al. (2013) | Mixed | RCT | 300 | 21 | LOGIC-insulin computerized | 80–110 | ABG: variable time interval: q1-4 h |
Krinsley et al. (2015) | Mixed | Retrospective | 3297 | 23 | Paper: Stamford | 70–140 | POC: q3 h |
Vogelzang et al. (2005) | SICU | Observational | 179 | 15 | GRIP | 72–135 | POC blood gas analyzer: variable |
Plank et al. (2006) | SICU: cardiothoracic surgery | RCT | 60 | 23 | eMPC versus paper | 80–110 | POC: variable sampling rate: q1 h-4 h |
Hovorka et al. (2007) | SICU: cardiac surgery | RCT | 60 | 45 | eMPC | 80–110 | Variable sampling rate: q1 h-4 h |
Saager et al. (2008) | SICU: cardiothoracic ICU | RCT | 40 | 100 | EndoTool (computer) versus paper | 90–150 | POC: hourly |
Dortch et al. (2008) | SICU: trauma ICU | RCT | 552 |  | Computer versus paper | 80–110 | POC q1-4 h |
Blaha et al. (2009) | SICU: cardiac surgery | RCT | 120 | 14 | eMPC versus paper (Matias versus Bath) | 80–110 | ABG: protocol dependent: q1-4 h |
Barletta et al. (2011) | SICU | Before–after | 192 | 28 | Computer versus paper | 80–110 | POC: variable sampling rate: q30 min-2 h versus q2 h |
Dumont et al. (2012) | SICU: cardiovascular ICU | RCT | 300 | 43 | Computer (EndoTool) versus paper (modified Portland) | 80–150 | NA |
Authors | Duration of glucose monitoring | Glucometric to measure target | % of time at target glycemia: intervention versus control group | Mean glycemia (mg/dl): intervention versus control group | Hypoglycemia: intervention versus control group | Glycemic variability | References |
|---|---|---|---|---|---|---|---|
Goldberg et al. (2004) | 61 h | Percent of hourly BG values in target range | 52% | 124 ± 15 | % of data at glc <60 mg/dl: 0.3% | NA | [8] |
Van den Berghe et al. (2006) | NR | Mean morning BG | NA | 111 ± 29 versus 153 ± 31 | % of patients: glc <40 mg/dl: 18.7 versus 3.1% | NA | [13] |
Kulnik et al. (2008) | 72 h | Percent of BG values in target | 47 ± 13% | 109 ± 13 | % data at glc <40 mg/dl: 0% | NA | [15] |
Shetty et al. (2012) | 59 h | Percent of BG values in target range | 42% | 156 ± 23 | % of data <70 mg/dl: 0.3% | NA | [37] |
Holzinger et al. (2010) | 72 h | CGM data: percent of data in target range | 59 ± 20 versus 55 ± 18 | 106 ± 18 versus 111 ± 10 | Rate: 1.9% versus 11.5% | NA | [9] |
De Block et al. (2015) | 96 h | CGM data: percent of data in target range | 37 ± 12 versus 34 ± 10 | 119 ± 17 versus 122 ± 11 | % of time at glc <60 mg/dl: 0.6 ± 1.6 versus 2.4 ± 4.3% | No differences between groups in SD, MAGE, MODD, CV | [6] |
Finney et al. (2003) | 22–89 h | Time spent in glucose band 80–110 mg/dl | 4 (0–20)% | NR | 0 ± 1% | NA | [31] |
Juneja et al. (2007) | NR | Percent of data in target range | 52 versus 32% | 107 ± 39 | % data at glc <50 mg/dl: 0.4 versus 0.5% | NA | [10] |
Chase et al. (2008) | 53 h | Percent of BG values in target | 54% | 108 ± 27 | % of data at glc <72 mg/dl: 3.8% | SD: 27 mg/dl | [4] |
Morris et al. (2008) | 4–22 days | Percent of BG values in target | 42 versus 28% | 116 versus 134 | % data at glc <40 mg/dl: 11.1 versus 5.1% | NA | [11] |
Preiser et al. GLUCONTROL (2009) | 48–216 h (=2–9 days) | Proportion of time of BG values in range | 43% | 117 (IQR: 108–130) mg/dl | Proportion of time at glc <40 mg/dl: 5.9 ± 27% | SD: 36 mg/dl | [12] |
NICE SUGAR (2009) | 4.2 days (1.9–9.0 days) | Time-weighted mean BG | NR | 115 ± 18 versus 144 ± 23 | % of patients: glc <40 mg/dl: 6.8 versus 0.5% | NA | [7] |
Marvin et al. (2013) | NR | Percent of hourly BG values in target range | 92% | 124 | % of data 40–70 mg/dl: 1.1% and in 17.6% of patients | NA | [34] |
Van Herpe et al. (2013) | 26–113 h | Percent of BG values in target range | 69 ± 17 versus 60 ± 19 | 106 ± 9 versus 107 ± 11 | % data at glc <60 mg/dl: 0.6 versus 1.2% | Max change in glc/24 h: 31 versus 37 mg/dl | [14] |
Krinsley et al. (2015) | 36–120 h | Percent of time of BG values in target range | Non-DM versus DM: 81 (61–94) versus 55 (35–71)% | Non-DM versus DM: 121 (112–133) versus 140 (128–155) mg/dl | % of patients: glc <70 mg/dl: non-DM versus DM: 18 versus 31% | CV: non-DM versus DM: 18 versus 27% | [33] |
Vogelzang et al. (2005) | 1.6 (0.8–4.7) days | Percent of time of BG values in target | 78 (66–88)% | 121 (108–135) | % of patients: glc <40: 0.6%; glc <63: 11.2% | NA | [38] |
Plank et al. (2006) | 48 h | Percent of time in target range | 52 (17–92) versus 19 (0–71)% | 117 (102–144) versus 131 (97–237) | Number of hypo episodes (<54 mg/dl) over 48 h: 0 versus 2 | NA | [35] |
Hovorka et al. (2007) | 24 h | Percent of time in target range | 60 ± 23 versus 28 ± 16 | 112 ± 20 versus 130 ± 20 | % of data at glc <52 mg/dl: 0% versus 0% | NA | [32] |
Saager et al. (2008) | 9 h | Percent of BG values in target | 84 versus 60% | 126 ± 18 versus 147 ± 27 | Episodes of hypo (<60 mg/dl) during ICU: 4 versus 1 | NA | [36] |
Dortch et al. (2008) | NR | Percent of BG values in target | 42 versus 34% | 116 ± 37 versus 120 ± 37 | % data at glc <40 mg/dl: 0.2 versus 0.5% | NA | [30] |
Blaha et al. (2009) | 45–48 h | Time in target range | 46 ± 3 versus 38 ± 3 versus 40 ± 3% | 106 ± 4 versus 121 ± 4 versus 117 ± 4 | Time in hypo (<52 mg/dl): 0 ± 0 versus 0.4 ± 0.2 versus 0.4 ± 0.3% | NA | [18] |
Barletta et al. (2011) | 67 versus 98 h | Percent of BG values in target | 49 ± 14 versus 40 ± 12 | 113 ± 11 versus 116 ± 11 | % data at glc <40 mg/dl: 2.1 versus 4.1% | SD: 25 ± 9 versus 31 ± 11 mg/dl | [29] |
Dumont et al. (2012) | NA | Percent of BG values in target range | 70 ± 15 versus 62 ± 18 | 138 ± 16 versus 141 ± 20 | Number of hypo events <60 mg/dl: 7 (5%) versus 18 (11%) | SD:36 ± 18 versus 42 ± 21 | [19] |