title: A simple insulin-nutrition protocol for tight glycemic control in critical illness: development and protocol comparison.
abstract: BACKGROUND
  Hyperglycemia is prevalent in critical care, and tight control can significantly reduce mortality. However, current protocols have been considered taxing to administer and may require extra staff. In addition, increased insulin resistance and saturation effects limit the level of control possible using insulin alone. Thus, regulating both insulin and exogenous nutritional inputs is required to control blood glucose.
  
  
  METHODS
  A robust, easy-to-use protocol ["SPRINT" (Specialized Relative Insulin Nutrition Tables)] that employs both insulin and feed modulation is developed and analyzed using retrospective data from 19 patients with average Acute Physiology and Chronic Health Evaluation II score of 21.8. Results are compared with several published protocols in simulation, and verified in a proof-of-concept trial.
  
  
  RESULTS
  In simulation, 61.7% of measurements were in the 75-110 mg/dL band and 83.5% in the 75-140 mg/dL band. Results from the simulation of published protocols agreed with published results. Clinically, for two patients, 64% and 85% of measurements were between 75 and 110 mg/dL during the two proof-of-concept trials. Total enteral feeding was similar to, or exceeded, retrospective data.
  
  
  CONCLUSIONS
  Tight control was achieved in simulation using a protocol that is easy to implement in an intensive care unit. Similarly tight control was also maintained during the two proof-of-concept clinical trials. Measurement frequency of 1-2 h is seen to be critical to achieving and maintaining tight control. The overall SPRINT protocol is easy to use for clinical staff and effective in achieving and maintaining normoglycemia in critical illness.
authors.affiliation: Department of Mechanical Engineering, University of Canterbury, Dunedin, New Zealand.
authors.forename: Timothy
authors.initials: T
authors.lastname: Lonergan
authors.forename: Aaron
authors.initials: A
authors.lastname: Le Compte
authors.forename: Mike
authors.initials: M
authors.lastname: Willacy
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Shaw
authors.forename: Xing-Wei
authors.initials: XW
authors.lastname: Wong
authors.forename: Thomas
authors.initials: T
authors.lastname: Lotz
authors.forename: Jessica
authors.initials: J
authors.lastname: Lin
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Hann
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition / Q000592:standards*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin