Background of tight glucose control

The Leuven trial: a paradigm change

In late 2001, Greet van den Berghe published "intensive insulin therapy in critically ill patients" in the New England Journal of Medicine. She and her co-workers found that in a large cohort of patients, lowering blood glucose values to normal levels (4.4 to 6.1 mmol/l, equivalent to 80 to 110 mg/dl) markedly improves outcome of these patients¹. This finding sparked much interest in glucose control in critically ill patients, and in recent years, many articles on the subject have been published. Krinsley partially reproduced the Leuven study, albeit in a before-after design instead of a randomized controlled design².
The "Surviving Sepsis Campaign" guidelines include glucose control in their recommended therapies³, and many ICUs have implemented at least some form of tighter glucose control since 2001.

Glucose control is hard to achieve

Physicians at many ICUs in which tight glucose control was performed have found that glucose control is hard to achieve. Some ICUs have experienced alarming rates of hypoglycemia, up to 42%⁴. An important advance to improve glucose control is the implementation of a protocol in which the nurse is the driving force, instead of the doctor^1,5.
However, most nurse-based protocols consist of a few simple rules on paper, and incidence of hypoglycemia is often 5-10 %. We hypothesized that a computer may integrate more information and use more complex calculations to achieve safer, more efficient glucose control. Read more on the GRIP as a CDSS page.

1. van den Berghe, G et al. Intensive insulin therapy in critically ill patients. [Pubmed][PDF (sign in needed)]
2. Krinsley, JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients.[Pubmed][PDF (free)]
3. Dellinger, RP et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. [Pubmed][Fulltext (sign in needed)]
4. Mackenzie, I et al. Tight glycaemic control: a survey of intensive care practice in large English hospitals.[Pubmed][PDF (sign in needed)]
5. Kanji, S et al. Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults. [Pubmed][PDF (sign in needed)]