Tight glucose control cuts surgical infections.
The study compared 288 patients on a moderate insulin protocol with 198 patients on a tight protocol. In the moderate protocol group, blood glucose was targeted to fall between 100 and 120 mg/dL, with insulin infusions initiated for levels consistently above 150 mg/dL. In the tight protocol group, blood glucose was targeted to fall between 80 and 110 mg/dL, with insulin infusions initiated for two blood glucose values above 120 mg/dL.
The overall infection rates were 34% in the tight protocol group and 48% in the moderate protocol group, said Dr. McElearney, a surgeon at the University of Virginia, Charlottesville.
"The degree of significance really surprised me, especially with the relatively small drop in mean blood glucoses," Dr. McElearney said in an interview. Although previous randomized, controlled trials have shown reduced morbidity and mortality with a tight glucose protocol, compared with a liberal protocol, tight protocols have not been compared with moderate protocols, and few studies have examined the effects of simply introducing a new protocol.
The mean daily insulin drip amount was significantly higher among patients in the tight protocol group during the study period, compared with the moderate protocol group: 37.1 U, compared with 31.9 U.
In patients who were on some form of insulin while in the ICU, the mean daily insulin drip increased from 34.6 U in the moderate protocol group to 41.6 U in the tight protocol group.
The average morning blood glucose decreased from 129 mg/dL in the moderate protocol group to 124 mg/dL in the tight protocol group.
The incidence of hyperglycemic episodes with blood glucose levels greater than 150 mg/dL fell in both groups: The rate of patient-days with hyperglycemic episodes was 56% in the moderate protocol group and 49% in the tight protocol group. Although hypoglycemic episodes with blood glucose levels less than 60 mg/dL increased from 6.0% in the moderate protocol group to 11% in the tight protocol group, few were symptomatic, and none of the patients suffered adverse effects from these episodes.
Patients in the tight protocol group had a 35% nosocomial infection rate, compared with 47% in the moderate protocol group.
BY HEIDI SPLETE
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|Publication:||Internal Medicine News|
|Date:||Jul 1, 2005|
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