title: Evaluation of glycemic control following discontinuation of an intensive insulin protocol.
abstract: BACKGROUND
  Intensive insulin protocols (IIPs) have been demonstrated to reduce morbidity and mortality in critically ill patients. Currently, there are no published studies evaluating glycemic control after discontinuation of an IIP.
  
  
  OBJECTIVE
  The purpose of this study was to compare blood glucose (BG) control during an IIP and for 5 days following its discontinuation (follow-up period).
  
  
  METHODS
  The study was a retrospective review of intensive care unit patients who received an IIP for >or=24 hours. Data were collected during the last 12 hours of the IIP and subsequent follow-up period.
  
  
  RESULTS
  For all 65 included patients, the mean +/- standard deviation for BG on the IIP was 123 +/- 26 mg/dL versus 168 +/- 50 mg/dL following discontinuation of the IIP (P < 0.001). The median (interquartile range) insulin that was administered decreased from 40 (22-65) units on the IIP to 8 (0-18) units after the IIP was stopped (P < 0.001). The mean daily BG during the follow-up period was significantly higher than that during the IIP (P < 0.001). Additionally, an insulin requirement of >20 units during the last 12 hours of the IIP was identified as a risk factor for poor glycemic control during the follow-up period (odds ratio: 4.62; 95% confidence interval: 1.17-18.17).
  
  
  CONCLUSIONS
  This study demonstrates a significant increase in BG following discontinuation of an IIP. Higher insulin requirements during the last 12 hours of an IIP were identified as an independent risk factor for poor glycemic control following the IIP. A standardized insulin transition protocol may help better control BG after discontinuation of an IIP.
authors.affiliation: Regional Medical Center at Memphis, Memphis, Tennessee, USA.
authors.forename: Quinn A
authors.initials: QA
authors.lastname: Czosnowski
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Swanson
authors.forename: Bob L
authors.initials: BL
authors.lastname: Lobo
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Broyles
authors.forename: Paul R
authors.initials: PR
authors.lastname: Deaton
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Finch
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism*; D004360:Drug Therapy, Computer-Assisted / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin