Target ranges and the apparent compliance with tight glycaemic control.
We performed a retrospective audit of blood glucose control after introducing a new protocol for insulin infusion. The audit showed a sustained reduction in the median blood glucose, which decreased from 7.0 to 6.8 mmol x l(-1), primarily because of a reduction in the proportion of values above 6 mmol x l(-1). When we examined the proportion of readings with previously published 'acceptable' ranges we found that small, probably clinically insignificant, changes in the accepted range have a major effect on apparent compliance with glycaemic control. This is because a large number of results fall within a narrow range of values. As a result there is a nearly 2.5-fold difference in compliance for a change in the upper limit of the target range of just 2.2 mmol x l(-1). Different target ranges have been recommended for tight glycaemic control. When comparing compliance with tight glycaemic control between intensive care units, target ranges should be identical.
Bone
E G
EG
Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK. edwinbone@doctors.org.uk
Young
D
D
Chantler
J
J
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004739:England; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D007362:Intensive Care Units / Q000592:standards*; D008485:Medical Audit / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies
D001786:Blood Glucose; D007328:Insulin