title: Trends in practice of blood glucose control in critically ill patients in the Netherlands.
abstract: BACKGROUND
  Publication of the Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial in 2009 and several observational studies caused a change in the recommendations for blood glucose control in intensive care patients. We evaluated local trends in blood glucose control in intensive care units in the Netherlands before and after the publication of the NICE-SUGAR trial and the revised Surviving Sepsis Campaign (SSC) guidelines in 2012.
  
  
  METHODS
  Survey focusing on the timing of changes in thresholds in local guidelines for blood glucose control and interrupted time-series analysis of patients admitted to seven intensive care units in the Netherlands from September 2008 through July 2014. Statistical process control was used to visualise and analyse trends in metrics for blood glucose control in association with the moment changes became effective.
  
  
  RESULTS
  Overall, the mean blood glucose level increased and the median percentage of blood glucose levels within the normoglycaemic range and in the hypoglycaemic range decreased, while the relative proportion of hyperglycaemic measurements increased. Changes in metrics were notable after publication of the NICE-SUGAR trial and the SSC guidelines but more frequent after changes in local guidelines; some changes seemed to appear independent of changes in local guidelines.
  
  
  CONCLUSIONS
  Local guidelines for blood glucose practice have changed in intensive care units in the Netherlands since the publication of the NICE-SUGAR trial and the revised SSC guidelines. Trends in the metrics for blood glucose control suggest new, higher target ranges for blood glucose control.
authors.affiliation: Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: R T M
authors.initials: RT
authors.lastname: van Hooijdonk
authors.forename: S
authors.initials: S
authors.lastname: Eslami
authors.forename: N F
authors.initials: NF
authors.lastname: de Keizer
authors.forename: F
authors.initials: F
authors.lastname: Bakhshi-Raiez
authors.forename: R J
authors.initials: RJ
authors.lastname: Bosman
authors.forename: D A
authors.initials: DA
authors.lastname: Dongelmans
authors.forename: P H J
authors.initials: PH
authors.lastname: van der Voort
authors.forename: J O
authors.initials: JO
authors.lastname: Streefkerk
authors.forename: W J
authors.initials: WJ
authors.lastname: Engelbrecht
authors.forename: J
authors.initials: J
authors.lastname: ten Cate
authors.forename: S
authors.initials: S
authors.lastname: Huissoon
authors.forename: E M
authors.initials: EM
authors.lastname: van Driel
authors.forename: I
authors.initials: I
authors.lastname: van Dijk
authors.forename: N
authors.initials: N
authors.lastname: Cimic
authors.forename: O F T
authors.initials: OF
authors.lastname: Beck
authors.forename: F T F
authors.initials: FT
authors.lastname: Snellen
authors.forename: N D
authors.initials: ND
authors.lastname: Holman
authors.forename: H C
authors.initials: HC
authors.lastname: Mulder
authors.forename: A
authors.initials: A
authors.lastname: Abu-Hanna
authors.forename: M J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D000368:Aged; D000465:Algorithms; D001786:Blood Glucose; D002985:Clinical Protocols; D003422:Critical Care / Q000639:trends*; D016638:Critical Illness; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents