title: The effect of a hypoglycemia treatment protocol on glycemic variability in critically ill patients.
abstract: BACKGROUND
  Hypoglycemia and glucose variability are independently associated with increased mortality in septic, surgical, and mixed intensive care unit (ICU) patients. Treatment of hypoglycemia with dextrose 50% can overcorrect blood glucose levels and increase glucose variability. The purpose of this study is to evaluate the effect of a hypoglycemia treatment protocol focused on minimizing glucose variability in critically ill patients.
  
  
  METHODS
  This retrospective analysis was conducted at a 772-bed community teaching hospital in Detroit, Michigan. A standardized nursing-driven hypoglycemia treatment protocol specific to critically ill patients was implemented. Glucose variability, amount of dextrose administered, subsequent glucose monitoring, hypoglycemia recurrence, and mortality were compared between pre- and postprotocol groups.
  
  
  RESULTS
  The coefficient of variability of blood glucose in the postprotocol group (n = 53) was decreased compared with the preprotocol group (n = 52), 40.9% versus 49.3%, respectively (P = .048). Dextrose usage was significantly reduced between groups (21.2 g preprotocol vs 11.5 g postprotocol; P < .001). The time to first blood glucose check was 36 minutes after protocol implementation compared to 61 minutes before the protocol (P = .003). Finally, the incidence of continued hypoglycemia following dextrose administration and ICU mortality was similar between groups.
  
  
  CONCLUSIONS
  Implementation of the hypoglycemia treatment protocol described led to a reduction in glucose variability, while still providing a safe and effective way to manage hypoglycemia in critically ill patients.
authors.affiliation: Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI, USA. pdarnold@umich.edu.
authors.forename: Patrick
authors.initials: P
authors.lastname: Arnold
authors.affiliation: Department of Pharmacy, St. John Hospital and Medical Center, Detroit, MI, USA.
authors.forename: Renee Alexander
authors.initials: RA
authors.lastname: Paxton
authors.affiliation: Department of Pharmacy, St. John Hospital and Medical Center, Detroit, MI, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: McNorton
authors.affiliation: Department of Medical Education, St. John Hospital and Medical Center, Detroit, MI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Szpunar
authors.affiliation: Department of Pharmacy, St. John Hospital and Medical Center, Detroit, MI, USA.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Edwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000401:mortality; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D005947:Glucose
keywords: dextrose; glucose variability; hypoglycemia; intensive care unit; protocol; treatment