title: Survey into blood glucose control in critically ill adult patients in the Netherlands.
abstract: BACKGROUND
  To study current clinical practice in blood glucose (BG) control in adult intensive care units (ICUs) in the Netherlands.
  
  
  METHODS
  We performed a national survey focusing on blood glucose targets, insulin administration, BG control guidelines, and opinions regarding BG control aiming for normoglycaemia (known as intensive insulin therapy, IIT).
  
  
  RESULTS
  The completed questionnaire was returned by 88/113 (78%) of the participating centres. In 98% (86/88) of the ICUs some sort of BG control was being practised. Half of the ICUs (42/86, 48%) used tight BG targets as with IIT; 28/86 (33%) and 13/86 (15%) used more liberal targets of 4.4 to 7.0 mmol/l and 4.4 to 8.0 mmol/l, respectively. Eighty-two (93%) reported having a local guideline on BG control (or IIT). The BG threshold to start insulin was 7.0+/-1.3 mmol/l vs 7.8+/-1.3 mmol/l in ICUs that practised IIT vs ICUs that practised less tight BG control, respectively (p=0.005). In 28/86 (33%) measurement of the BG values was done according to a strict time schedule (i.e., BG values were measured on predefined time points). While respondents were fairly agreed on the benefits of IIT, opinions regarding ease of implementation and time needed to apply this strategy varied. In addition, severe hypoglycaemia was considered a serious side effect of IIT.
  
  
  CONCLUSIONS
  Approximately half of the ICUs in the Netherlands reported having implemented IIT. However, the full guideline as used in the original studies on IIT was hardly ever implemented. Concerns about severe hypoglycaemia, at least in part, hampers implementation of IIT.
authors.affiliation: Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. m.j.schultz@amc.uva.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: J M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: R E
authors.initials: RE
authors.lastname: Harmsen
authors.forename: M J
authors.initials: MJ
authors.lastname: de Graaff
authors.forename: J C
authors.initials: JC
authors.lastname: Korevaar
authors.forename: F
authors.initials: F
authors.lastname: van Braam Houckgeest
authors.forename: J P
authors.initials: JP
authors.lastname: van der Sluijs
authors.forename: H
authors.initials: H
authors.lastname: Kieft
authors.forename: P E
authors.initials: PE
authors.lastname: Spronk
mesh_terms: D000328:Adult; D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring; D016001:Confidence Intervals; D016638:Critical Illness; D019538:Health Care Surveys; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D007362:Intensive Care Units; D016015:Logistic Models; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin