Using the Glucometrics Website to Benchmark ICU Glucose Control Before and After the NICE-SUGAR Study

Abstract

Prior to 2009, intensive glycemic control was the standard in main intensive care units (ICUs). Glucose targets have been recalibrated after publication of the NICE-SUGAR study in that year, followed by updated guidelines that endorsed more moderated control. We sought to determine if the prevalence of hyperglycemia in US ICUs had increased after the NICE-SUGAR study's results were reported. We used data from hospitals submitted to the Yale Glucometrics™ website to assess mean blood glucose values, percentage of blood glucose within various ranges, and the prevalence of hypo-and hyperglycemic excursions, based on the patient-day method, comparing the pre-to post-NICE-SUGAR time period. Among more than a total of 2 million blood glucose determinations, comprising 408 790 patient-days, median patient-day blood glucose decreased from 144 mg/dL to 141 mg/dL (P < .001) in the pre-versus post-NICE-SUGAR time period. The percentage of patient days with a mean blood glucose of 110-179 mg/dl increased from 58.3 to 63.6%. The percentage of patient-days with either hypoglycemia (<70 mg/dl) or severe hyperglycemia (≥300 mg/dl) decreased during this time. Our results suggest that glycemic control in US ICUs has improved when comparing time periods before versus after publication of the NICE-SUGAR study. We found no evidence that fewer hypoglycemic events were achieved at the expense of more hyperglycemia.

Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients

“…Severe hypoglycemia was defined as glucose < 2.2 mmol/L (40 mg/dL) throughout the hospitalization (Hypo Severe ). The 3.9 mmol/l threshold is consistent with the typical threshold for treatment in the hospital and both 3.9 mmol/L and 2.2 mmol/L are definitions used by published studies of hospitalized patients and glucometric tools [5, 22–24].…”

The Blood Glucose Regulation in Intensive Care Unit (ICU)

“…Pada tahun 2009, penelitian Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) mengungkapkan terdapat peningkatan angka kematian pada pasien yang menjalani kontrol glukosa ketat sebesar 81-108 mg/dL, sedangkan target kontrol glukosa moderat sebesar 140-180 mg/dL dikaitkan dengan angka kelangsungan hidup yang lebih tinggi. 6 Studi multisenter ini menekankan risiko signifikan episode hipoglikemik dengan kontrol glukosa ketat karena kedekatannya dengan batas bawah kadar glukosa darah. [6][7][8] Terlepas dari diabetes mellitus (DM), ada banyak skenario klinis lain yang dapat menyebabkan perubahan kadar glukosa darah pada pasien yang sakit kritis, meskipun penderita diabetes merupakan yang paling rentan terhadap perubahan ini.…”

“…6 Studi multisenter ini menekankan risiko signifikan episode hipoglikemik dengan kontrol glukosa ketat karena kedekatannya dengan batas bawah kadar glukosa darah. [6][7][8] Terlepas dari diabetes mellitus (DM), ada banyak skenario klinis lain yang dapat menyebabkan perubahan kadar glukosa darah pada pasien yang sakit kritis, meskipun penderita diabetes merupakan yang paling rentan terhadap perubahan ini. [9][10][11] Pasien yang sakit kritis biasanya dirawat di ICU dengan hiperglikemia yang diinduksi oleh stres (50%-85%).…”