Failure to achieve euglycemia despite aggressive insulin control signals abnormal physiologic response to trauma.
OBJECTIVE
We hypothesize that a failure to normalize a patient's glucose on an automated euglycemia protocol signals an adverse response after trauma and that this response can identify patients with an increased mortality.


METHODS
There were 1246 ventilated, critically ill trauma patients who were placed on an automated euglycemia. All glucose values collected both by laboratory serum measurements and by bedside arterial samples were included in the analysis.


RESULTS
Forty six thousand two hundred eighteen data entries for glucose (mg/dL) were analyzed. Time to normalization, defined as the first value in the goal range of 80 to 110 mg/dL, was different between the 2 groups, survivors correcting significantly faster (396 vs 487 minutes; P = .003). Mortality in patients who normalized (80-110 mg/dL) in the first 6 hours of admission was 13.6% vs 18.3% in patients requiring greater than 6 hours (P = .02). Patients who never normalized also required significantly greater insulin doses despite there being no significant difference in demographic data between the 2 groups.


CONCLUSIONS
A posttraumatic patient's response to tight glycemic control revealed important prognostic information about the patients' physiologic status. Patients who failed to reach euglycemia in the first 6 hours of admission had an increased hospital mortality. The time to normalization is significantly longer in those patients who died. Patients who did not correct rapidly required significantly higher insulin doses, suggesting insulin resistance.
Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA. nmowery@wfubmc.edu
Nathan T
NT
Mowery
Oliver L
OL
Gunter
Lesly A
LA
Dossett
Marcus J
MJ
Dortch
John A
JA
Morris
Addison K
AK
May
Jose J
JJ
Diaz
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002985:Clinical Protocols; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D017211:Treatment Failure; D014947:Wounds and Injuries / Q000097:blood* / Q000401:mortality* / Q000628:therapy
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin