Evaluation of an updated insulin infusion protocol at a large academic medical center

2016 ◽  
Vol 73 (11_Supplement_3) ◽  
pp. S88-S93 ◽  
Author(s):  
Gabrielle A. Gibson ◽  
Michael A. Militello ◽  
Jorge A. Guzman ◽  
Seth R. Bauer
Keyword(s):  
Insulin Infusion ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Insulin Infusion Protocol ◽  
Infusion Protocol

Intravenous Insulin Infusion Protocol Compared With Subcutaneous Insulin for the Management of Hyperglycemia in Critically Ill Adults

2019 ◽  
Vol 53 (9) ◽  
pp. 894-898 ◽  
Author(s):  
Kenneth K. Tran ◽  
Jeffery L. Kibert ◽  
Evan D. Telford ◽  
Andrew J. Franck
Keyword(s):  
Insulin Infusion ◽  
Medical Center ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Lower Proportion ◽  
Insulin Regimen ◽  
Support Tool ◽  
Intravenous Insulin ◽  
Insulin Infusion Protocol ◽  
Infusion Protocol

Background: The use of an intravenous insulin infusion protocol (IIP) is recommended for management of hyperglycemia in the intensive care unit (ICU); however, limited evidence of comparison has been made with subcutaneous (SC) insulin regimens. Objective: This study aims to evaluate the safety and effectiveness of an IIP compared with SC insulin regimens in an ICU patient sample since the implementation of an IIP using a computerized clinical-decision support tool. Methods: This investigation was a retrospective cohort study of patients who were treated for hyperglycemia while admitted to any of the ICUs at a Veterans Affairs Medical Center. Patients who were treated with either an IIP or a scheduled SC insulin regimen between May 1, 2015, and May 25, 2016, were included for evaluation. Results: Blood glucose (BG) was within the normoglycemia range (70-180 mg/dL) for 63.0% of the measurements in patients treated with an IIP (n = 171) compared with 45.7% in those treated with SC insulin regimens (n = 121; P < 0.01). Overall, patients managed with an IIP had a lower proportion of hypoglycemic BG measurements (1.2% vs 2.1%, P < 0.01), a lower proportion of hyperglycemic BG measurements (35.8% vs 52.2%, P < 0.01), and a lower mean BG (172.4 vs 194.3 mg/dL, P < 0.01). Conclusion and Relevance: The results of this study suggest that an IIP in a sample of adult ICU patients was associated with better BG control and lower occurrence of hypoglycemia compared with SC insulin regimens.

scholarly journals Use of Continuous Glucose Monitor in Critically Ill COVID-19 Patients Requiring Insulin Infusion: An Observational Study

2021 ◽  
Author(s):  
Eileen R Faulds ◽  
Andrew Boutsicaris ◽  
Lyndsey Sumner ◽  
Laureen Jones ◽  
Molly McNett ◽  
...  
Keyword(s):  
Insulin Infusion ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Median Number ◽  
Continuous Glucose Monitor ◽  
Academic Medical ◽  
Validation Criteria ◽  
Time In Range ◽  
Staff Workload

Abstract Context The coronavirus disease 2019 (COVID-19) pandemic has created a need for remote blood glucose (BG) monitoring in the intensive care unit (ICU). Objective To evaluate feasibility and patient safety of a hybrid monitoring strategy of point of care (POC) BG plus continuous glucose monitor (CGM) in the ICU. Design Retrospective analysis. Setting ICU of an academic medical center. Patients Patients with COVID-19 on intravenous (IV) insulin. Intervention After meeting initial validation criteria, CGM was used for IV insulin titration and POC BG was performed every 6 hours or as needed. Main Outcome Measures Outcomes included frequency of POC BG, workflow, safety, and accuracy measures. Results The study included 19 patients, 18 with CGM data, mean age 58 years, 89% on mechanical ventilation, 37% on vasopressors, and 42% on dialysis. The median time to CGM validation was 137 minutes (interquartile range [IQR] 114-206). During IV insulin, the median number of POC values was 7 (IQR 6-16) on day 1, and declined slightly thereafter ( 71% reduction compared to standard of 24 /day). The median number of CGM values used nonadjunctively to titrate IV insulin was 11.5 (IQR 0, 15) on day 1 and increased thereafter. Time in range 70-180mg/dl was 64+/-23% on day 1 and 72+/-16% on day 2-7 while time &lt;70 mg/dl was 1.5 +/-4.1% on day 1 and &lt;1% on days 2-7. Conclusions This study provides data to support that CGM using a hybrid protocol is feasible, accurate, safe, and has potential to reduce nursing and staff workload.

scholarly journals Treatment of Hypertriglyceridemia with Aggressive Continuous Intravenous Insulin

2021 ◽  
Vol 24 ◽  
pp. 336-342
Author(s):  
Abigail Hoff ◽  
Kara Piechowski
Keyword(s):  
Median Time ◽  
Triglyceride Level ◽  
Insulin Infusion ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Retrospective Case ◽  
Intravenous Insulin ◽  
Academic Medical ◽  
Severe Hypertriglyceridemia

Purpose: Severe hypertriglyceridemia requiring hospitalization for intravenous insulin to lower triglycerides and prevent complications of pancreatitis is becoming an increasing problem with little consensus treatment evidence. This is the largest case series to date to evaluate this under-studied area of literature. The objective of this study was to determine the average time to triglyceride lowering less than 500 mg/dL. Methods: This was a retrospective case series from March 2018 to March 2020 at a single rural academic medical center. 23 patients were included who received weight-based intravenous insulin at 0.1 units/kg/hour through a hypertriglyceridemia management order-set over a two-year period. Results: The median triglyceride level at initiation of the insulin infusion was 3759 mg/dL with an interquartile range of 5555. The median time to a triglyceride level less than 1000 mg/dL and 500 mg/dL was 45 hours (1.8 days) and 75 hours (3.1 days) respectively. Patients remained on intravenous insulin for a median of 60 hours (2.5 days). Conclusions: In this largest case series to date evaluating the use of intravenous insulin for the treatment of hypertriglyceridemia, a weight-based insulin infusion demonstrated reduction of triglyceride levels to less than 1000 mg/dL in approximately 2 days and less than 500 mg/dL in approximately 3 days.

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
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