Glycemic control in the ICU: a multicenter survey.
BACKGROUND
Intensive insulin therapy has recently been shown to decrease morbidity and mortality in the critically ill population in a large randomized clinical trial.


OBJECTIVE
To determine the beliefs and attitudes of ICU clinicians about glycemic control.


METHODS
Self-administered survey.


METHODS
ICU nurses and physicians in five university-affiliated multidisciplinary ICUs.


RESULTS
A total of 317 questionnaires were returned from 233 ICU nurses and 84 physicians. The reported clinically important threshold for hypoglycemia was 4 mmol/l (median, IQR 3-4 mmol/l). In non-diabetic patients, the clinically important threshold for hyperglycemia was 10 mmol/l (IQR 9-12 mmol/l); however, nurses had a significantly higher threshold than physicians (difference of 0.52 mmol/l (95% CI 0.09-0.94 mmol/l, P=0.018). In diabetic patients, the clinically important threshold for hyperglycemia was also 10 mmol/l (IQR 10-12 mmol/l), and again nurses had a significantly higher threshold than physicians (0.81 mmol/l, 95% CI 0.29-1.32 mmol/l, P=0.0023). Avoidance of hyperglycemia was judged most important for diabetic patients (87.7%, 95% CI 84.1-91.3%), patients with acute brain injury (84.5%, 95% CI 80.5-88.5%), patients with a recent seizure (74.4%, 95% CI 69.6-79.3%), patients with advanced liver disease (64.0%, 95% CI 58.7-69.3%), and for patients with acute myocardial infarction (64.0%, 95% CI 58.7-69.3%). Physicians expressed more concern than nurses about avoiding hyperglycemia in patients with acute myocardial infarction ( P=0.0004). ICU clinicians raised concerns about the accuracy of glucometer measurements in critically ill patients (46.1%, 95% CI 40.5-51.6%).


CONCLUSIONS
Attention to these beliefs and attitudes could enhance the success of future clinical, educational and research efforts to modify clinician behavior and achieve better glycemic control in the ICU setting.
McMullin
Joseph
J
Department of Medicine, McMaster University Medical Center, 1200 Main Street West, Hamilton, Ontario, Canada.
Brozek
Jan
J
Jaeschke
Roman
R
Hamielec
Cindy
C
Dhingra
Vinay
V
Rocker
Graeme
G
Freitag
Andreas
A
Gibson
James
J
Cook
Deborah
D
D001291:Attitude of Health Personnel; D001786:Blood Glucose; D002170:Canada; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose