title: Initial experience with an intensive care hyperglycemia protocol in a Saudi Arabian intensive care unit.
abstract: OBJECTIVE
  To study the efficacy of nurse-driven intensive glucose management protocol in an intensive care setting.
  
  
  METHODS
  This cohort study took place at King Abdul-Aziz National Guard Hospital, Al-Hasa, Saudi Arabia from April 2005 through June 2005. We modified a validated nurse-driven glycemic protocol when glucose level was >11.1 mmol/L. Protocol was applied to 103 consecutive patients. Three months after implementing the protocol, we analyzed the glucose control and relevant patient variables. To check the efficacy, glucose values were compared with patients admitted consecutively 2 months prior to the implementation of the protocol. Duration and mean insulin infusion rates were also recorded. A brief nursing survey was also conducted.
  
  
  RESULTS
  The median blood glucose upon ICU admission was 8.7 mmol/L (interquartile range 6.9-12.05). Our cohort included 45 patients with history of diabetes while the remaining 58 were non-diabetics. Mean blood glucose decreased from 10 +/- 4.4 mmol/L on admission to 8.2 +/- 1.8 mmol/L for the duration of ICU stay. Protocol was effective in both diabetics and non-diabetics. Insulin infusion was employed in 33 patients. Median insulin infusion rate required throughout the ICU length of stay was 4.3 units/hour. Duration and rate of insulin infusion were not statistically significant between diabetics and non-diabetics. The glucose control was significantly better when compared with the prior practices of glucose control.
  
  
  CONCLUSIONS
  Our study demonstrates that nurse-driven hyperglycemia protocol were manageable to used in critically ill patients. Moreover, the protocol is equally effective in both diabetic and non-diabetic patients.
authors.affiliation: Department of Medicine, King Abdul-Aziz National Guard Hospital, Al-Hasa, Kingdom of Saudi Arabia.
authors.forename: Mobeen
authors.initials: M
authors.lastname: Iqbal
authors.forename: Abdulsalam M
authors.initials: AM
authors.lastname: Al-Aithan
authors.forename: Rifat
authors.initials: R
authors.lastname: Rehmani
authors.forename: Mohsen
authors.initials: M
authors.lastname: Eledrisi
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000451:nursing*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D012529:Saudi Arabia; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin