title: Using the glucometrics website to benchmark ICU glucose control before and after the NICE-SUGAR study.
abstract: Prior to 2009, intensive glycemic control was the standard in main intensive care units (ICUs). Glucose targets have been recalibrated after publication of the NICE-SUGAR study in that year, followed by updated guidelines that endorsed more moderated control. We sought to determine if the prevalence of hyperglycemia in US ICUs had increased after the NICE-SUGAR study's results were reported. We used data from hospitals submitted to the Yale Glucometrics™ website to assess mean blood glucose values, percentage of blood glucose within various ranges, and the prevalence of hypo- and hyperglycemic excursions, based on the patient-day method, comparing the pre- to post-NICE-SUGAR time period. Among more than a total of 2 million blood glucose determinations, comprising 408 790 patient-days, median patient-day blood glucose decreased from 144 mg/dL to 141 mg/dL (P < .001) in the pre- versus post-NICE-SUGAR time period. The percentage of patient days with a mean blood glucose of 110-179 mg/dl increased from 58.3 to 63.6%. The percentage of patient-days with either hypoglycemia (<70 mg/dl) or severe hyperglycemia (≥300 mg/dl) decreased during this time. Our results suggest that glycemic control in US ICUs has improved when comparing time periods before versus after publication of the NICE-SUGAR study. We found no evidence that fewer hypoglycemic events were achieved at the expense of more hyperglycemia.
authors.affiliation: Section of Endocrinology, Yale School of Medicine, New Haven, CT.
authors.forename: Ranee R
authors.initials: RR
authors.lastname: Lleva
authors.affiliation: Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT Yale-New Haven Health System, New Haven, CT.
authors.forename: Prem
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Yale-New Haven Health System, New Haven, CT.
authors.forename: Janis E
authors.initials: JE
authors.lastname: Bozzo
authors.affiliation: Yale-New Haven Health System, New Haven, CT.
authors.forename: Karrie C
authors.initials: KC
authors.lastname: Hendrickson
authors.affiliation: Section of Endocrinology, Yale School of Medicine, New Haven, CT Yale-New Haven Health System, New Haven, CT silvio.inzucchi@yale.edu.
authors.forename: Silvio E
authors.initials: SE
authors.lastname: Inzucchi
mesh_terms: D019985:Benchmarking; D001786:Blood Glucose / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology*; D007003:Hypoglycemia / Q000097:blood / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007362:Intensive Care Units / Q000592:standards*; D020407:Internet; D017410:Practice Guidelines as Topic; D015995:Prevalence
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: NICE-SUGAR study; diabetes; glucometrics; glucose; hospital; inpatient