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Insulin therapy and blood glucose management in critically ill patients: a 1-day cross-sectional observational study in 69 French intensive care units.

Authors :
Desgrouas, Maxime
Demiselle, Julien
Stiel, Laure
Brunot, Vincent
Marnai, Rémy
Sarfati, Sacha
Fiancette, Maud
Lambiotte, Fabien
Thille, Arnaud W.
Leloup, Maxime
Clerc, Sébastien
Beuret, Pascal
Bourion, Anne-Astrid
Daum, Johan
Malhomme, Rémi
Ravan, Ramin
Sauneuf, Bertrand
Rigaud, Jean-Philippe
Dequin, Pierre-François
Boulain, Thierry
Source :
Annals of Intensive Care; 6/17/2023, Vol. 13 Issue 1, p1-13, 13p
Publication Year :
2023

Abstract

Background: Hyperglycaemia is common in critically ill patients, but blood glucose and insulin management may differ widely among intensive care units (ICUs). We aimed to describe insulin use practices and the resulting glycaemic control in French ICUs. We conducted a multicentre 1-day observational study on November 23, 2021, in 69 French ICUs. Adult patients hospitalized for an acute organ failure, severe infection or post-operative care were included. Data were recorded from midnight to 11:59 p.m. the day of the study by 4-h periods. Results: Two ICUs declared to have no insulin protocol. There was a wide disparity in blood glucose targets between ICUs with 35 different target ranges recorded. In 893 included patients we collected 4823 blood glucose values whose distribution varied significantly across ICUs (P < 0.0001). We observed 1135 hyperglycaemias (> 1.8 g/L) in 402 (45.0%) patients, 35 hypoglycaemias (≤ 0.7 g/L) in 26 (2.9%) patients, and one instance of severe hypoglycaemia (≤ 0.4 g/L). Four hundred eight (45.7%) patients received either IV insulin (255 [62.5%]), subcutaneous (SC) insulin (126 [30.9%]), or both (27 [6.6%]). Among patients under protocolized intravenous (IV) insulin, 767/1681 (45.6%) of glycaemias were above the target range. Among patients receiving insulin, short- and long-acting SC insulin use were associated with higher counts of hyperglycaemias as assessed by multivariable negative binomial regression adjusted for the propensity to receive SC insulin: incidence rate ratio of 3.45 (95% confidence interval [CI] 2.97–4.00) (P < 0.0001) and 3.58 (95% CI 2.84–4.52) (P < 0.0001), respectively. Conclusions: Practices regarding blood glucose management varied widely among French ICUs. Administration of short or long-acting SC insulin was not unusual and associated with more frequent hyperglycaemia. The protocolized insulin algorithms used failed to prevent hyperglycaemic events. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
21105820
Volume :
13
Issue :
1
Database :
Complementary Index
Journal :
Annals of Intensive Care
Publication Type :
Academic Journal
Accession number :
164369529
Full Text :
https://doi.org/10.1186/s13613-023-01142-9