title: A comparison of two insulin infusion protocols in the medical intensive care unit by continuous glucose monitoring.
abstract: BACKGROUND
  Achieving good glycemic control in intensive care units (ICU) requires a safe and efficient insulin infusion protocol (IIP). We aimed to compare the clinical performance of two IIPs (Leuven versus modified Yale protocol) in patients admitted to medical ICU, by using continuous glucose monitoring (CGM). This is a pooled data analysis of two published prospective randomized controlled trials. CGM monitoring was performed in 57 MICU patients (age 64 ± 12 years, APACHE-II score 28 ± 7, non-diabetic/diabetic: 36/21). The main outcome measures were percentage of time in normoglycemia (80-110 mg/dl) and in hypoglycemia (<60 mg/dl), and glycemic variability (standard deviation, coefficient of variation, mean amplitude of glucose excursions, mean of daily differences).
  
  
  RESULTS
  Twenty-two subjects were treated using the Leuven protocol and 35 by the Yale protocol; >63,000 CGM measurements were available. The percentage of time in normoglycemia (80-110 mg/dl) was higher (37 ± 15 vs. 26 ± 11%, p = 0.001) and percentage of time spent in hypoglycemia was lower (0[0-2] vs. 5[1-8]%, p = 0.001) in the Yale group. Median glycemia did not differ between groups (118[108-128] vs. 128[106-154] mg/dl). Glycemic variability was less pronounced in the Yale group (median SD 28[21-37] vs. 47[31-71] mg/dl, p = 0.001; CV 23[19-31] vs. 36[26-50]%, p = 0.001; MODD 35[26-41] vs. 60[33-94] mg/dl, p = 0.001). However, logistic regression could not identify type of IIP, diabetes status, age, BMI, or APACHE-II score as independent parameters for strict glucose control.
  
  
  CONCLUSIONS
  The Yale protocol provided better average glycemia, more time spent in normoglycemia, less time in hypoglycemia, and less glycemic variability than the Leuven protocol, but was not independently associated with strict glycemic control.
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Faculty of Medicine, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium. christophe.deblock@uantwerpen.be.
authors.forename: Christophe E M
authors.initials: CEM
authors.lastname: De Block
authors.affiliation: Intensive Care Unit, ZNA, General Hospital Middelheim, Antwerp, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Rogiers
authors.affiliation: Intensive Care Unit, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
authors.affiliation: Intensive Care Unit, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Schepens
authors.affiliation: A. Menarini Diagnostics, Scientific and Technology Affairs, Florence, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Scuffi
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Faculty of Medicine, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
authors.forename: Luc F
authors.initials: LF
authors.lastname: Van Gaal
keywords: Continuous glucose monitoring; Hypoglycemia; Insulin infusion protocol; Intensive care unit