title: Assessment of quality of glycemic control in intensive care patients treated with an insulin infusion at a teaching hospital.
abstract: OBJECTIVE
  To describe the quality of glycemic control in patients in intensive care units (ICUs) treated with an intravenous (IV) insulin infusion at a teaching hospital.
  
  
  METHODS
  This retrospective study included patients admitted to the ICU and treated with an IV insulin infusion for at least 12 h between August 1 and November 30, 2011. Medical charts were reviewed. The primary quality indicator for glycemic control was the mean percent of blood glucose values per patient in the 6.1 to 8 mmol/L target range.
  
  
  RESULTS
  A total of 351 patients were included; 61.5% of subjects had no known diabetes. Admissions were mainly for surgery (61.3%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16.8±7.3. The mean percent of blood glucose values per patient in the 6.1 to 8 mmol/L range was 35% for all subjects and 26.2% for patients with diabetes. If a target of 6.1 to 10 mmol/L was considered, those values became 63% and 54.6%. At least 1 episode of hyperglycemia (>10 mmol/L), hypoglycemia (<4 mmol/L) or severe hypoglycemia (<2.2 mmol/L) was documented in 68%, 9% and 1% of subjects, respectively. Glycemic variability (SD) was 1.9 mmol/L, and the median hyperglycemic index was 0.77 (interquartile [IQ]: 0.24 to 1.63).
  
  
  CONCLUSIONS
  The quality of glycemic control in patients in the ICU at our hospital needs to be improved. A new computerized IV insulin protocol is currently being tested.
authors.affiliation: Département de Pharmacie, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. Electronic address: lyne.gauthier.chum@ssss.gouv.qc.ca.
authors.forename: Lyne
authors.initials: L
authors.lastname: Gauthier
authors.affiliation: Département de Pharmacie, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: Pharmacy Department, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Anne-Isabelle
authors.initials: AI
authors.lastname: Dubé
authors.affiliation: Département de Pharmacie, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Patrick Viet-Quoc
authors.initials: PV
authors.lastname: Nguyen
authors.affiliation: Département de Pharmacie, Centre hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec; and Centre de recherche clinique Etienne-Le Bel, Sherbrooke and Faculté de Pharmacie, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Beauchesne
authors.affiliation: Service d'Endocrinologie, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Boutin
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002170:Canada / Q000453:epidemiology; D003422:Critical Care; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006784:Hospitals, Teaching; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control*; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: critical care; glycemic control; insuline intraveineuse; intravenous insulin; maîtrise glycémique; soins critiques