title: Comparison of the efficacy and safety of two different insulin infusion protocols in the medical intensive care unit.
abstract: BACKGROUND
  New guidelines recommend using less intensive glycemic goals in critically ill patients receiving insulin infusions.
  
  
  OBJECTIVE
  To compare the efficacy and safety of a modified insulin infusion protocol (MIIP) with less stringent blood glucose (BG) goals to an intensive insulin infusion protocol (IIIP) in patients in a medical intensive care unit (MICU).
  
  
  METHODS
  Retrospective review of patients receiving an insulin infusion for at least 24 hours. Patients treated for hyperglycemic emergencies were excluded. The primary endpoint of the study was mean area under the BG curve (BG-AUC) at 24 and 48 hours. Other endpoints included mean BG, hours until BG at goal, rate of BG above goal, frequency of BG measurements, and rate of hypoglycemia.
  
  
  RESULTS
  BG-AUC at 24 hours was similar between the groups (MIIP = 5177.7 ± 1221.3 mg/dL x h vs IIIP = 4850.3 ± 1301.7 mg/dL x h; P = .20). The mean BG level at 24 hours was 225.1 ± 91.1 mg/dL in the MIIP group and 205.7 ± 89.7 mg/dL in the IIIP group (P = .06). In the MIIP group, 61.7% of the BG levels were above goal as compared to 87.5% in the IIIP group (P < .0001). Patients were able to achieve BG goals faster with the MIIP (12.58 ± 10.5 hours vs 29.37 ± 16.8 hours; P < .001). The rate of severe hypoglycemia was lower at 24 hours in the patients following the MIIP (0% vs 0.3%; P = .01).
  
  
  CONCLUSIONS
  The study showed that by having less intensive glycemic goals, goal BG levels can achieved faster and the rate of severe hypoglycemia can decrease.
authors.affiliation: Associate Professor, Temple University School of Pharmacy, Philadelphia, Pennsylvania.
authors.forename: Mirza E
authors.initials: ME
authors.lastname: Perez
authors.affiliation: Associate Professor, Temple University School of Pharmacy, Philadelphia, Pennsylvania.
authors.lastname: Bcps
authors.affiliation: Associate Professor, Temple University School of Pharmacy, Philadelphia, Pennsylvania.
authors.forename: Lindsay I
authors.initials: LI
authors.lastname: Varga
authors.affiliation: Clinical Pharmacy Specialist in Internal Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.lastname: Bcps
authors.affiliation: Associate Professor, Temple University School of Pharmacy, Philadelphia, Pennsylvania.
authors.forename: Christina
authors.initials: C
authors.lastname: Rose
authors.affiliation: Assistant Professor, Temple University School of Pharmacy, Philadelphia, Pennsylvania.
authors.lastname: Bcps
authors.affiliation: Associate Professor, Epidemiology and Biostatistics, and Director, Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
keywords: insulin infusion; intensive care unit; protocol