Masafumi Suga, MB
Kobe City Medical Center General Hospital
Kobe, Japan
Disclosure information not submitted.
Takeshi Nishimura
M.D.
Hyogo medical emergency hospital, United States
Disclosure information not submitted.
Satoshi Ishihara
M.D.
Hyogo Emergency Medical Center, United States
Disclosure information not submitted.
Title: Usefulness of a Dynamic Scale for Blood Glucose Control in the Mixed Intensive Care Unit
Introduction: A dynamic scale (DS) helps determine insulin dosages per changes in blood glucose levels in addition to absolute values. A DS may be more useful than the conventional sliding scale (SS) for blood glucose management in the intensive care units (ICUs), but its validation is limited. We compared the effectiveness of the DS in our emergency ICU, which is mixed medical-surgical-trauma ICU, before and after its introduction (Nov 2018) and examined its usefulness.
Methods: We conducted a retrospective observational study of all patients admitted to the emergency ICU who required continuous insulin administration from Apr 2016 to Mar 2021. Patients with diabetic ketoacidosis and hyperglycemic hyperosmolar state were excluded. Patients after and before DS introduction comprised the DS and SS groups, respectively. We evaluated the hypoglycemia frequency (< 90 mg/dL), blood glucose variability rate (standard deviation of blood glucose/mean×100) (%), target blood glucose achievement rate (100–180 mg/dL) (%), high blood glucose recurrence, and number of blood glucose measurements. We used propensity score methods adjusting for patient characteristics (age, gender, body mass index, diabetes mellitus history, primary diagnosis, and blood glucose level on ICU admission).
Results: In total, 112 patients were included who received continuous intravenous insulin infusion managed with the DS (n=54) or SS (n=58). The median age was 69 years [interquartile range (IQR): 60–77.3] and Acute Physiologic Assessment and Chronic Health Evaluation II score was 25 (IQR: 20–33), with no significant difference between the two groups (P=0.87). Glycemic variability was significantly lower (27.5% vs. 34.9%, P=0.0014), and hypoglycemia frequency was less frequent in the DS group than in the SS group (5.56% vs. 31.0%, P< 0.001). There were no significant differences in the other glycemic parameters between the two groups. For propensity score matching, we included 40 patients from each group, revealing a significant difference in glycemic variability (27.5% vs. 33.7%, P=0.026) and hypoglycemia frequency (7.5% vs. 32.5%, P=0.005), similar to the simple univariable analysis results.
Conclusions: In mixed ICU glucose management, the DS reduced blood glucose variability and hypoglycemia frequency compared with the SS.