title: Implementation of a tight glycaemic control protocol using a web-based insulin dose calculator.
abstract: We describe the implementation of a glucose control protocol supported by a web-based insulin dose calculator in a 16-bedded intensive care unit. The protocol was introduced and then modified after 15 months' use. Glucose concentrations were retrospectively reviewed and compared for the 9-month period before introduction of the protocol (288 patients), for 15 months after its introduction (502 patients) and for a further 5 months after its modification to increase insulin dose (101 patients). The mean (SD) blood glucose concentrations decreased from 7.3 (1.8) mmol.l(-1) to 6.6 (1.6) mmol.l(-1) and then to 6.2 (1.3) mmol.l(-1). The proportion of values < 8.0 mmol.l(-1) increased from 69% to 81% and then to 89%. Blood glucose concentrations were increased by the use of intravenous nutrition and by vasoactive drugs but not by the administration of propofol. The odds ratio [95% CI] for death for glucose values > 8.0 mmol.l(-1) was 2.10 [1.19-3.73] compared to values < 6.1 mmol.l(-1). However, patient mortality remained constant during the study. Glycaemic control was improved outside a research setting using a protocol supported by a web-based insulin dose calculator.
authors.affiliation: Intensive Care Unit, Hope Hospital, Stott Lane, Salford, M6 8HD, UK. tony.thomas@srht.nhs.uk
authors.forename: A N
authors.initials: AN
authors.lastname: Thomas
authors.forename: A E
authors.initials: AE
authors.lastname: Marchant
authors.forename: M C
authors.initials: MC
authors.lastname: Ogden
authors.forename: S
authors.initials: S
authors.lastname: Collin
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods* / Q000592:standards; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D020407:Internet; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin