title: Glycemic control in a medical intensive care setting: revision of an intensive care unit nurse-driven hyperglycemia protocol.
abstract: The purpose of this study was to determine whether the addition of rapid-acting insulin bolus for enteral feed coverage and a reduction in basal insulin improve glycemic control and decrease hypoglycemia in a medical intensive care unit. A quasi-experimental posttest design assessing glucose control postimplementation of a revised nurse-driven ICU hyperglycemia protocol was conducted on a 16-bed medical intensive care unit at a multicenter hospital system. A daily report of all patients on the ICU hyperglycemia protocol was automated for the inpatient diabetes management team, and pertinent data were collected. Univariate statistics were conducted for all variables. The variability in blood glucose based on different clinical variables was compared using t tests. The hypoglycemic rate was only 0.72%, and no glucose value was less than 40 mg/dL. In addition, the mean glucose value throughout the study was 160.9 ± 35.6 mg/dL. Findings from this study will hopefully provide insight on an effective way to control glucose within a medical intensive care unit as well as reduce hypoglycemia rates within this setting.
authors.affiliation: Division of Nursing, Winston-Salem State University, Winston-Salem, North Carolina (Dr Dodson); and Inpatient Diabetes Program (Ms Simpson) and Critical Care Medicine (Dr Feinstein), Cone Health, Greensboro, North Carolina.
authors.forename: Crystal H
authors.initials: CH
authors.lastname: Dodson
authors.forename: Jenny
authors.initials: J
authors.lastname: Simpson
authors.forename: Daniel
authors.initials: D
authors.lastname: Feinstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D003422:Critical Care / Q000379:methods; D064648:Critical Care Nursing / Q000379:methods*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000451:nursing* / Q000517:prevention & control*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin