Nicole Palm, BCCCP, PharmD
Clinical Pharmacy Specialist
Cleveland Clinic Main Campus
Cleveland, Ohio
Disclosure information not submitted.
Dianna Copley, CCRN, CNS, DNP
Clinical Nurse Specialist
Cleveland Clinic, United States
Disclosure information not submitted.
Sarah Welch, PharmD
Field Medical Director
Pfizer, United States
Disclosure information not submitted.
Title: Insulin infusion management of glucose post-auto-islet cell transplantation in the ICU
Introduction: Total pancreatectomy with auto-islet cell transplant is a treatment option for chronic pancreatitis. Islet cells are transplanted from the removed pancreas to prevent creation of a new diabetic state post-operatively. In protecting the freshly transplanted islet cells, good glycemic control is paramount. Historic data suggests that patients receiving islet transplant may require tighter blood glucose control and more frequent monitoring than other ICU patients. However, no data in the modern era of NICE-SUGAR has evaluated this claim. Although current target blood glucose goal is less than 160 mg/dL, the ICU insulin nomogram titrates to 140-179 mg/dL in accordance with ICU standards of care.
Methods: Patients admitted to our academic medical center surgical ICU following auto-islet transplantation between 2012 and 2020 were reviewed in the electronic medical record for inclusion. Patients in whom an insulin infusion was not used were excluded. Data regarding insulin and glucose management and diet were collected. The primary outcome was percentage of blood glucose values within target of less than 160 mg/dL. Secondary outcomes included evaluating transition off of insulin drips and the incidence of hypoglycemia. Subgroups based on monitoring intensity were compared (every 3 hours standard, every 1 hour = tight).
Results: 45 patients were included in analysis. Twenty patients (42%) had an adjusted blood glucose target goal compared to the standard nomogram goal of 140-179 mg/dL. Mean duration of infusion was 16.9 hours. With a standard nomogram 321 (58.5%) blood glucose readings were less than 160 mg/dL during their ICU stay. Of total readings, including those on non-standard nomograms, 164 (66.7%) achieved goal. The incidence of hypoglycemia between groups was low, with one patient in the standard monitoring and titration group, vs. two patients with tight control and monitoring.
Conclusions: Use of a standard ICU nomogram appears safe and effective in managing islet cell transplant recipients. Tighter control and monitoring than standard ICU treatment is not necessary in management, and may correlate to higher incidence of hypoglycemia.