A low-cost, effective intervention that can profoundly affect patients adn will eventually become a standard of care in ICUs (intensive care units) worldwide. James Krinsley, M.D., the author of the study, is director of critical care at The Stamford Hospital in Stamford, Conn., Dr. Krinsley says conducting the study in a community hospital should give other hospitals confidence that they can maintain the necessary level of glucose monitoring and treatment without being a large-scale research hospital.
Dr. Krinsley analyzed 800 consecutive patients admitted to the unit just prior to institution of the glucose management protocol and compared them to the first 800 consecutive patients admitted after the protocol was put into place. The protocol involved intensive monitoring of the glucose levels in patients and treating any elevation over 140 milligrams per deciliter (mg/dL) with injections of insulin under the skin or continuous intravenous insulin infusions, depending on the level of elevation.
The hospital mortality rate of the treated patients decreased 29.3 percent. This represents 49 saved lives from the first 800 patients treated with the protocol. There was also a decrease in the development of new kidney failure and a decrease in the need for red blood cell transfusions. The ICU length of stay decreased among the patients treated with the protocol.
The current study from Stamford Hospital is the first to show that intensive glucose management can improve survival among a general population of critically ill patients, similar to the patients found in the majority of ICUs around the world.
The standard of care in ICUs until recently was to accept moderate elevations of glucose, even up to 200-225 mg/dL, without using insulin treatment, says Dr. Krinsley. The current study will help to change that paradigm, he says. Mayo Clinic Proceedings August 2004