[Efficiency and safety evaluation of glucose control in critically ill patients].
OBJECTIVE
To evaluate the efficiency and safety of the computerized glucose control protocol in critically ill patients.


METHODS
The patients who were admitted to intensive care unit (ICU) from June 2005 through December 2007 were retrospectively analyzed. Based on the glucose-control target, patients were divided into two groups: group A (target range was 4.4-6.1 mmol/L, 857 cases); group B (target range was 7.3-8.3 mmol/L, 894 cases). The computerized protocol of glucose management was applied for blood glucose controlling.


RESULTS
A total of 1 751 patients were enrolled, and 26 222 recorded data were analyzed. The mean blood glucose was (5.99+/-0.54) mmol/L and (7.43+/-0.84) mmol/L, respectively, and both of them were controlled within the target range. The incidence of hypoglycemia (<3.3 mmol/L) was 1.65% (197/11,933) in group A and 1.04% (149/14,289) in group B. The incidence of severe hypoglycemia (<2.2 mmol/L) was 0.07 % (8/11 933) and 0.12% (17/14,289) respectively. No adverse events occurred. The number of patients in whom glucose-control target rate was reached was less in patients receiving enteral nutrition (EN, group A 38.77%, group B 19.15%) than those with total parenteral nutrition (TPN) in both two groups (group A 50.81%, group B 23.40%, both P<0.01). However, hyperglycemia (>8.3 mmol/L) incidence in EN patients (group A 13.68%, group B 38.61%) was higher than that in TPN patients (group A 8.77%, group B 29.05%, both P<0.01). No significant correlations were found between hypoglycemia and nutrition support methods (EN or TPN).


CONCLUSIONS
Blood glucose levels could be controlled effectively and safely within a target range without significant increase in the incidence of hypoglycemia, whereas number of determination is decreased, by using the computerized glucose control protocol. However, our protocol needs further improvement, especially in EN patients.
Intensive Care Unit, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Wei
W
He
Yang
Y
Liu
Tong
T
Li
Hua
H
Zhou
Jing
J
Hou
Tong-yan
TY
Zhang
Dong
D
Zhao
Yuan
Y
Xu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D016638:Critical Illness; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin