title: Intensive versus modified conventional control of blood glucose level in medical intensive care patients: a pilot study.
abstract: BACKGROUND
  Critically ill postsurgical patients fare better with intensive control of blood glucose level. The link between glucose control and outcome is less well studied for medical intensive care patients. Whether intensive glucose control requires additional staffing is unclear.
  
  
  OBJECTIVE
  To compare intensive glucose control with modified conventional control in the medical intensive care unit and to assess compliance with glucose targets, incidence of hypoglycemia, and staffing adequacy.
  
  
  METHODS
  Medical intensive care patients who had been receiving mechanical ventilation for less than 24 hours were randomized to intensive or modified conventional protocols for glucose control. Nurses were trained before participating in the study and were interviewed after its completion.
  
  
  RESULTS
  Five subjects were randomized to each protocol. Mean blood glucose levels were 5.8 (SD 1.5) mmol/L (105.3 [SD 26.3] mg/dL) for the intensive group and 9.8 (SD 2.5) mmol/L (177.4 [SD 45.5] mg/dL) for the modified conventional group (P < .001). Fifty percent of glucose levels met target values in the intensive group, and 72% of glucose levels met target values in the modified conventional group (P < .001). Severe hypoglycemia (glucose <2.2 mmol/L [<40 mg/dL]) occurred rarely and without complication. Nurses suggested protocols might be improved by using smaller steps in adjusting insulin dosage and reported that simultaneously caring for more than 1 study subject was taxing.
  
  
  CONCLUSIONS
  Target levels for blood glucose were achieved with both protocols. Severe hypoglycemia was rare and uncomplicated regardless of type of glucose control. Additional staffing may be needed for intensive glucose control.
authors.affiliation: Department of Medicine, Loma Linda University School of Medicine, CA, USA.
authors.forename: David Kelvin
authors.initials: DK
authors.lastname: Bland
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Fankhanel
authors.forename: Eileen
authors.initials: E
authors.lastname: Langford
authors.forename: Martha
authors.initials: M
authors.lastname: Lee
authors.forename: Scott W
authors.initials: SW
authors.lastname: Lee
authors.forename: Colleen
authors.initials: C
authors.lastname: Maloney
authors.forename: Mark
authors.initials: M
authors.lastname: Rogers
authors.forename: Grenith
authors.initials: G
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin