A simple insulin-nutrition protocol for tight glycemic control in critical illness: development and protocol comparison.
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.
Lonergan
Timothy
T
Department of Mechanical Engineering, University of Canterbury, Dunedin, New Zealand.
Le Compte
Aaron
A
Willacy
Mike
M
Chase
J Geoffrey
JG
Shaw
Geoffrey M
GM
Wong
Xing-Wei
XW
Lotz
Thomas
T
Lin
Jessica
J
Hann
Christopher E
CE
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
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin