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Achieving Optimal Glucose Control in Critical Care Units at Atrium Health

Objective

The objective of this study was to evaluate the impact of different blood glucose (BG) target ranges for IV insulin infusions on inpatient glucose metrics, specifically focusing on hypo and hyperglycemic events, duration of IV insulin therapy, and length of stay (LOS) in the hospital.

Setting

The study was conducted at Atrium Health Wake Forest Baptist, using de-identified data from the EndoTool IV (ETIV) database. The data comprised 73,458 patients runs with IV insulin in various inpatient settings, including critical care units, during the year 2023. The study involved patients managed for conditions such as diabetic ketoacidosis (DKA) and stress-related hyperglycemia.

Results

Comparison of BG Target Ranges:

  • Target ranges analyzed: 90-120 mg/dL, 100-140 mg/dL, 120-160 mg/dL, and 140-180 mg/dL.
  • Goal in Target Range: Highest percentage for BG 100-140 mg/dL (57.5%).
  • Hypoglycemia Incidents:
    • BG < 70 mg/dL: Lowest for BG 140-180 mg/dL (0.16%).
    • BG < 40 mg/dL: Lowest for BG 140-180 mg/dL (0.01%).
  • Hyperglycemia Incidents:
    • BG > 180 mg/dL: Increased with lower target ranges, lowest for BG 140-180 mg/dL (4.2%).
  • Duration of IV Insulin:
    • Shortest duration for BG 140-180 mg/dL (26.0 hours).
    • BG 120-160 mg/dL also showed a reduced duration (27.5 hours).
  • Statistical Significance:
    • Significant differences in hypoglycemia rates between BG target ranges compared to BG 140-180 mg/dL.
Conclusions

The study suggests that for a heterogeneous inpatient population treated with IV insulin, targeting a BG range of 120-160 mg/dL using the EndoTool IV (ETIV) algorithm results in minimal hypo and hyperglycemic events. This range provides an optimal balance between achieving glucose control and minimizing the risks associated with dysglycemia, while also reducing the duration of IV insulin therapy and potentially lowering the length of stay in the ICU and hospital. These findings support the evolving best practices for BG management in critical care settings.

Authors

C. Price, J. Aloi

Source

American Diabetes Association 84th Scientific Sessions

Year

2024