A comparison study of continuous insulin infusion protocols in the medical intensive care unit: Computer‐guided vs. standard column‐based algorithms

Abstract PURPOSE: To compare the safety and efficacy of continuous insulin infusion (CII) via a computer‐guided and a standard paper form protocol in a medical intensive care unit (ICU). METHODS: Multicenter randomized trial of 153 ICU patients randomized to CII using the Glucommander (n = 77) or a standard paper protocol (n = 76). Both protocols used glulisine insulin and targeted blood glucose (BG) between 80 mg/dL and 120 mg/dL. RESULTS: The Glucommander resulted in a lower mean BG value (103 ± 8.8 mg/dL vs. 117 ± 16.5 mg/dL, P < 0.001) and in a shorter time to reach BG target (4.8 ± 2.8 vs.7.8 hours ± 9.1 hours, P < 0.01), and once at target resulted in a higher percentage of BG readings within target (71.0 ± 17.0% vs. 51.3 ± 19.7%, P < 0.001) than the standard protocol. Mean insulin infusion rate in the Glucommander was similar to the standard protocol ( P = 0.12). The percentages of patients with ≥1 episode of BG <40 mg/dL and <60 mg/dL were 3.9% and 42.9% in the Glucommander and 5.6% and 31.9% in the standard, respectively [ P = not significant (NS)]. Repeated measures analyses show that the probabilities of BG reading <40 mg/dL or <60 mg/dL were not significantly different between groups ( P = 0.969, P = 0.084) after accounting for within‐patient correlations with or without adjusting for time effect. There were no differences between groups in the length of hospital stay ( P = 0.704), ICU stay ( P = 0.145), or inhospital mortality ( P = 0.561). CONCLUSION: Both treatment algorithms resulted in significant improvement in glycemic control in critically ill patients in the medical ICU. The computer‐based algorithm resulted in tighter glycemic control without an increased risk of hypoglycemic events compared to the standard paper protocol. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.