Changing practice with changing research: results of two UK national surveys of intensive insulin therapy in intensive care patients.
We conducted two telephone surveys of all United Kingdom adult intensive care units in 2007/8 and 2010 to assess practice with regard to intensive insulin therapy for glycaemic control in critically ill patients, and to assess the change in practice following publications in 2008 and 2009 that challenged the evidence for this therapy. Of 243 units that had a written policy for intensive insulin therapy in 2007/8, 232 (96%) still had a policy in 2010. One hundred and six (46%) units had updated their policy in response to new evidence, whereas 126 (54%) stated that it had remained the same. Where intensive care units had changed their policy, we found a significant increase in target limits and a wider target range. Regional variations in practice were also seen. Across seven regions, the percentage of units where the glycaemic control policy had been updated since 2007/8 varied from nil to 78.9%.
Intensive Care Unit, Royal Cornwall Hospital NHS Trust, Truro, UK. jonathan.paddle@rcht.cornwall.nhs.uk
J J
JJ
Paddle
R L
RL
Eve
K A
KA
Sharpe
D001786:Blood Glucose / Q000378:metabolism; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods* / Q000639:trends; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D006113:United Kingdom
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin