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Byline: Mathijs Vogelzang (1), Bert G. Loef (1), Joost G. Regtien (1), Iwan C. C. Horst (2), Hein Assen (1), Felix Zijlstra (2), Maarten W. N. Nijsten (1) Keywords: Insulin; Glucose; Critically ill; Computer decision support Abstract: Objective Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients. Design and setting Observational cohort study in three intensive care units (32 beds) in a 1,300-bed university teaching hospital. Patients All 2,800 patients admitted to the surgical, neurosurgical, and cardiothoracic units the study period started at each ICU after implementation of Glucose Regulation for Intensive Care Patients (GRIP), a freely available computer-assisted glucose control protocol. Measurements and results We analysed compliance in relation to recommended insulin pump rates and glucose measurement frequency. Patients were on GRIP-ordered pump rates 97% of time. Median measurement time was 5a-min late (IQR 20a-min early to 34a-min late). Hypoglycemia was uncommon (7% of patients for mild hypoglycemia, Conclusions Our computer-assisted glucose control protocol provides safe and efficient glucose regulation in routine intensive care practice. A low rate of hypoglycemic episodes was achieved with a considerably lower number of glucose measurements than used in most other schemes. Author Affiliation: (1) Department of Critical Care, University Medical Center, University of Groningen, 9700 RB, Groningen, The Netherlands (2) Department of Cardiology, University Medical Center, University of Groningen, 9700 RB, Groningen, The Netherlands Article History: Registration Date: 11/03/2008 Received Date: 21/12/2007 Accepted Date: 10/03/2008 Online Date: 04/04/2008 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1091-y) contains supplementary material, which is available to authorized users.

Byline: Marjolijn N. de Hooge (1), Bas H. Verhoeven (2), Willem J. M. J. Rutten (1), Maarten W. N. Nijsten (2) Author Affiliation: (1) Hospital Pharmacy, Groningen University Hospital, PO Box 30.001, 9700 RB, Groningen, The Netherlands (2) Surgical Intensive Care Unit, Groningen University Hospital, 9700 RB, Groningen, The Netherlands Article History: Received Date: 12/10/2002 Accepted Date: 06/12/2002 Article note: Electronic Publication