Improving blood sugar control during critical illness: a cohort study

Abstract

Purpose: The aim of this study is to compare blood sugar control and safety profile of nurse-titrated and medically ordered glucose-insulin regimens. Materials and Methods: We conducted a retrospective cohort study in a 9-bedded regional intensive care unit (ICU) in Queensland, Australia. Seventy critically ill patients requiring one-on-one nursing and intravenous insulin were included. In the nursing group, the ICU nurse decided initial and ongoing insulin infusion rates and glucose measurement frequency. The medical group had a traditional insulin sliding scale prescription. Results: Thirty-seven patients in the nursing group had 1949 glucose measurements. Thirty-three patients in the medical group had 2118 measurements. Mean blood sugar levels (±SD) were 8.33 ± 2.34 and 8.78 ± 2.74 in nursing and medical groups (P b .001). Eighteen percent of glucose readings were greater than 10 mmol/L in the nursing group compared with 27% in the medical group (P = .038). The incidence of hypoglycemia (b2.2 mmol/L) was similar in the 2 groups. Conclusions: In a regional ICU, nurse-titrated glycemic control is safe, effective, and results in high compliance with a glucose target range.