Insulin therapy and blood glucose management in critically ill patients: a 1-day cross-sectional observational study in 69 French intensive care units
Authors' conclusion
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.
Study context
- Population
- Adult ICU patients hospitalized for acute organ failure, severe infection or post-operative care, 69 French intensive care units (ICUs)
- Participants
- 893 patients · 69 ICUs
- Outcome
- Insulin use practices and resulting glycaemic control
- Follow-up
- 1 day (November 23, 2021)
Methodological detailsmulticentre, 1-day observational
- Multicentre
- 1-day observational
Main finding
As reported in the abstract
Insulin use and glycaemic control
- ICUs with no insulin protocol
- 2
- Different blood glucose target ranges between ICUs
- 35
- Blood glucose values collected (distribution varied across ICUs, P < 0.0001)
- 4823
- Patients with hyperglycaemia (> 1.8 g/L); 1135 episodes
- 402 (45.0%)
- Patients with hypoglycaemia (≤ 0.7 g/L); 35 episodes
- 26 (2.9%)
- Severe hypoglycaemia (≤ 0.4 g/L) instances
- 1
- Patients receiving insulin
- 408 (45.7%)
- Intravenous (IV) insulin only
- 255 [62.5%]
- Subcutaneous (SC) insulin only
- 126 [30.9%]
- Both IV and SC insulin
- 27 [6.6%]
- Glycaemias above target under protocolized IV insulin
- 767/1681 (45.6%)
Observational data: associations, not effects.
Further findings
Hyperglycaemia counts with SC insulin among insulin-treated patients
| IRR (95% CI) | P value | ||
|---|---|---|---|
| Short-acting SC insulin | 3.45 (2.97–4.00) | P < 0.0001 | |
| Long-acting SC insulin | 3.58 (2.84–4.52) | P < 0.0001 | |
| 0.20.5125Incidence rate ratio (log scale) |
- Hyperglycaemia counts with SC insulin among insulin-treated patients: multivariable negative binomial regression adjusted for the propensity to receive SC insulin
Original publication
Insulin therapy and blood glucose management in critically ill patients: a 1-day cross-sectional observational study in 69 French intensive care units. Ann Intensive Care. Published 17 June 2023. doi:10.
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