(266) Intensive Insulin Infusion Protocols: A Pre- and Post-Implementation Analysis

Introduction: Hyperglycemia and insulin resistance are common in critically ill patients. The 2012 SCCM guidelines for insulin infusions emphasize the use of an insulin infusion protocol that requires minimal nursing bedside decision-making and suggest computerized decision-support systems deliver favorable outcomes. To align with evidence-based guidelines and to adhere to regulations set by the Joint Commission, we created a web-based, critical care insulin infusion calculator to replace our historical “nurse-driven” protocol. The purpose of our research was to compare glycemic control and incidence of hypoglycemia in an adult critical care population using the nurse-driven protocol versus a web-based, critical care insulin infusion calculator. We hypothesized the web-based insulin calculator would provide better glucose control with less episodes of hypoglycemia.

Methods: This retrospective, observational cohort trial with pre- and post-implementation analysis included patients ≥ 18 years prescribed a critical care insulin infusion protocol for at least 24 hours. Patients with DKA or HHS were excluded. Data was collected from April to December 2019 and June to December 2022. The primary outcome assessed glycemic control, defined as the percentage of blood glucose results within the range of 120 to 180 mg/dL. Secondary outcomes evaluated incidence of moderate (glucose 40 to 69 mg/dL) and severe hypoglycemia (glucose less than 40 mg/dL).

Results: A total of 127 patients were enrolled; 71 pre and 56 post-implementation. Target glucose was attained in 54.9% (1,105 levels) of pre compared with 53.9% (1,201 levels) of the post-implementation group (p = 0.76). There were 3 (0.15%) episodes of moderate hypoglycemia in the pre and 7 (0.31%) in the post-implementation group (p = 0.34). Severe hypoglycemia occurred in 1 (0.05%) patient in the pre, and 0 in the post-implementation group (p = 0.49).

Conclusions: Among critical care patients prescribed either a nurse-driven or calculator-based intensive insulin infusion protocol, there was no difference in glycemic control or incidence of hypoglycemia. In comparison to the nurse-drive protocol, the calculator-based intensive insulin protocol fulfills regulatory requirements and aligns with published guidelines.