title: Management of diabetes mellitus and hospital-related hyperglycemia in patients of a medical ICU, with the use of two "down-to-earth" protocols: a feasibility study.
abstract: OBJECTIVE
  Optimal control of blood glucose in the ICU has been shown to significantly decrease mortality and morbidity of severely ill patients. The purpose of the present project was to develop and implement undemanding, "down-to-earth" protocols, enabling tight glucose control in critically ill patients, in the setting of a city hospital ICU with limited personnel and facilities.
  
  
  METHODS
  From January 2003 to January 2006, a total of 745 patients (3197 patient-days) were treated for hyperglycemia in our medical ICU. On July 2003 two different intensive insulin therapy protocols were implemented: A protocol of continuous intravenous insulin, including specific algorithms for calculation of initial insulin bolus, initial infusion rate and further adjustment plan, was used for patients with compromised peripheral tissue perfusion. For patients with stable circulation, a protocol of subcutaneous intensive insulin therapy, including a formula for calculation of daily insulin dosage in previously non-insulin-treated diabetics, was adopted. 134 patients were treated during the run-in phase of the project and 539 patients were treated during the main treatment phase. 72 patients treated for hyperglycemia in our ICU prior to the implementation of the two protocols (from January 2003 to July 2003) served as controls.
  
  
  RESULTS
  After the implementation of the two protocols, a marked overall increase of normoglycemic blood glucose values (64.7% vs. 48.5%, P<0.001), a decrease of manifest hyperglycemias (6.4% vs. 17.4%, P<0.001) and an increase in hypoglycemic events (1.8% vs. 0.7%, P<0.001) was observed. Seven cases of severe hypoglycemia requiring glucose infusion were observed during the main treatment phase (0.3%). No hypoglycemia-associated deaths occurred.
  
  
  CONCLUSIONS
  The combined implementation of the two protocols presents a simple, safe and effective way of pursuing normoglycemia in critically ill patients.
authors.affiliation: Klinikum Hannover Nordstadt, Medizinische Klinik, Department of Medicine, Krankenhaus Nordstadt, Klinikum Region Hannover, Hannover, Germany. johannes.hensen.nordstadt@krh.eu
authors.forename: J
authors.initials: J
authors.lastname: Hensen
authors.forename: T
authors.initials: T
authors.lastname: Thomas
authors.forename: J
authors.initials: J
authors.lastname: Mueller-Ziehm
authors.forename: W
authors.initials: W
authors.lastname: Worthmann
authors.forename: E
authors.initials: E
authors.lastname: Kleine
authors.forename: E-M
authors.initials: EM
authors.lastname: Behrens
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D003422:Critical Care; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D018709:Statistics, Nonparametric
chemical_list: D001786:Blood Glucose; D007328:Insulin