Evaluation of Glycemic Control Following Discontinuation of an Intensive Insulin Protocol

BACKGROUND: Intensive insulin protocols (IIPs) have been demonstrated to reduce morbidity and mortality in critically ill patients. Currently, there are no published studies evaluating glycemic control after discontinuation of an IIp OBJECTIVE: The purpose of this study was to compare blood glucose (BG) control during an IIP and for 5 days following its discontinuation (follow-up period). METHODS: The study was a retrospective review of intensive care unit patients who received an IIP for >= 24 hours. Data were collected during the last 12 hours of the IIP and subsequent follow-up period. RESULTS: For all 65 included patients, the mean standard deviation for BG on the IIP was 123 +/- 26 mg/dL versus 168 +/- 50 mg/dL following discontinuation of the IIP (P < 0.001). The median (interquartile range) insulin that was administered decreased from 40 (22-65) units on the IIP to 8 (0-18) units after the IIP was stopped (P < 0.001). The mean daily BG during the follow-up period was significantly higher than that during the IIP (P < 0.001). Additionally, an insulin requirement of > 20 units during the last 12 hours of the IIP was identified as a risk factor for poor glycemic control during the follow-up period (odds ratio: 4.62; 95% confidence interval: 1.17-18.17). CONCLUSIONS: This study demonstrates a significant increase in BG following discontinuation of an IIP. Higher insulin requirements during the last 12 hours of an IIP were identified as an independent risk factor for poor glycemic control following the IIP A standardized insulin transition protocol may help better control BG after discontinuation of an IIP. Journal of Hospital Medicine 2009;4:28-34. (c) 2009 Society of Hospital Medicine.