Table 1

Summary of studies included in the present evaluation
Ref. (year)
 Number of patients and category
 Blood glucose target (mmol/l)
 Method
 Used BG meter
 Frequency of measurements
 Hypoglycaemia (mmol/l)
 Results (mmol/l)
[1]
 765 Thoracosurgical ICU patients
 4.4–6.1
 Start at BG >6.1 mmol/l. Insulin ± 0.1–2 IU/hour depending on last two BG values. Glucose infusion or feeding
 ICU based ABL700® bloodgas/BG analyzer. Arterial blood samples
 1–4 hours
 5.1% of patients <2.2
 Mean morning BG 5.7 ± 1.1
[4] (2004)
 27 Mixed ICU patients
 4–7
 Bath IIP: insulin ± 0.5–4 IU/hour, depending on last two BG values
 Accu Check® Advantage 2. Mostly arterial samples
 1–2 hours
 Three BG values <2.2
 Median BG 6.6
[2] (2004)
 800 Mixed ICU patients
 <7.7
 Insulin sc. If two BG values >11.1 mmol/l: insulin iv, sliding scale. Glucose infusion/feeding
 Finger stick samples or plasma BG (Vitros® lab analyzer)
 Every 3 hours if sc, hourly if iv
 0.34% of patients <2.2
 Mean BG 7.2 70% of BG <7.7
[5] (2001)
 20 Critically ill diabetic patients
 6.7
 Insulin iv between -1.5 and +1.5 IU/hours depending on last two BG values. Glucose-potassium infusions
 OneTouch® II. Capillary samples
 4 hours
 No BG <2.5
 Mean BG 7.8 ± 0.2
[6] (2004)
 118 Cardiothoracic ICU patients
 5.5–7.7
 Yale IIP. Insulin ± 0.5–10 IU, depending on last two BG values and infusion rate
 OneTouch® Surestep Flex
 1 hour
 0.2% of BG <3.3
 73% between 4.4 and 7.7
[7] (2004)
 52 Medical ICU patients
 5.5–7.7
 Yale IIP. Insulin ± 0.5–10 IU, depending on last two BG values and infusion rate
 OneTouch® Surestep Flex
 1–4 hours
 0.3% of BG <3.3
 66% between 4.4 and 7.7
[3] (2004)
 50 Mixed ICU patients
 4.5–6.1
 Insulin ± 0.5–2 IU/hour, depending on last two BG values. Dextrose infusion or feeding
 Accu Check® Inform. Capillary samples
 1–2 hours
 4% of patients <2.2
 11.5 ± 3.7 hours/day between 4.5 and 6.1
[8] (2004)
 168 Cardiothoracic ICU patients
 4.4–8.3
 Insulin 1–16 IU/hour + bolus, sliding scale, depending on last BG value
 Accu Check® Inform. Venous samples
 1–4 hours
 7.1% of BG <2.2
 61% of BG between 4.4 and 8.3
[9] (2003)
 17 Diabetic patients, acute medical diseases
 6–7
 GIK + bolus, insulin 1–4 IU/h, dynamic scale, depending on last BG value
 Hemocue® meter. Capillary samples
 1 hour
 Four times
 Mean BG 10.1
[10] (2002)
 37 Postsurgical NIDDM patients
19 patients sc, 18 patients iv, sliding scale, 5% glucose infusion
 Glucometer®. Capillary samples
 4 hours
 5.6% of patients in iv group
 sc mean: 7.2 ± 1.2 iv mean: 7.3± 1.1
[11] (2004)
 72 Cardiothoracic diabetic patients
 6.9–11.1
 GIK protocol. Continuous GIK infusion + insulin bolus if BG >15 mmol/l
 ?
 1 hour
Mean BG 7.7 ± 0.2
[31] (1996)
 60 Surgical NIDDM patients
 3.3–11.1
 Insulin bolus if BG >11.1 mmol/l. Group 1: saline. Group 2: glucose-insulin. Group 3: bolus every 2 hours
 Capillary samples
 15 min
 No
 Mean BG <9 within all groups
[12] (2002)
 29 Diabetic patients, cardiac surgery, 5 days
 6.7–11.1
 Start if BG >7.8 mol/l. Sliding scale
 Venous and capillary samples
 Six measurements per day
 0.2% of BG <3.8
 Mean BG 9.5
[13] (1997)
 595 Diabetic patients, cardiac surgery
 <11.1 l
 Portland protocol: insulin depending on last two BG values and insulin infusion rate
 Glucometer
 1–2 hourly
Mean BG 9.7
[14] (1987)
 24 Diabetic patients after surgery
 6.7–10
 Insulin ± 0.5 IU/hour depending on BG. Bolus if BG >13.3 mol/l. 5% dextrose infusion
 Accu Check + strips
 2 hourly
 1.4% of measurements
 Mean BG between 6.7 and 10
[15] (1988)
 30 Diabetic patients, perioperative
 5–10
 Group 1: iv, every 4 hours ± 0.5 IU/hour. Group 2: sc, every 4 hours ± 2 IU/4 hours. Glucose-potassium infusion
 Glucometer
 Hourly during surgery, 4 hourly after surgery
 0.6% of measurements <2.8 in iv group
 67% of iv group between 5.0 and 10; 40% in sc group
[17] (2002)
 188 Patients, during cardiac surgery
 4.4–6.6
 Start (2 IU/hour) with BG >6.6 mmol/l. Double infusion rate until BG <6.6 mol/l.
 ?
 20 min
 12% of patients with BG <3.8
 In 23% of patients BG <8.3
[18] (1994)
 77 Diabetic patients, surgery
 6.7–10
 Insulin ± 0.5–1.0 U/hr depending on BG
 Reflolux S (+strips) and Glucose hexokinase (lab)
 4 hourly, hourly during surgery
 Two patients
 62% of patients BG between 3.5 and 15.0
[19] (2000)
 24 Type 2 diabetic patients, acute myocardial infarction
 8.3–11.0
 Insulin ± 1–2 IU/h, depending on BG range.
 Venous samples. Automatic analyzer (lab)
 30 min to 2 hours
Mean BG 6.9 ± 0.8
[20] (2002)
 25 Diabetic patients, acute coronary syndromes
 6.6–8.2
 Insulin change by -1 to +3 IU/hour, depending on BG
 Beckman® glucose analyzer II
 1–3 hourly
 Four patients with mild hypoglycaemia
 Mean 7.2 ± 1.7
[21] (1999)
 25 Patients, acute stroke (during 24 hours)
 4–7
 GIK: 500 ml glucose 10% + 16 U insulin + 20 mmol KCl; 100 ml/hour. ± 4 U insulin/infusate, depending on BG
 BM Glycemic strips
 2 hourly
 One patient
 Mean BG of 68% of patients <7
[22] (1992)
 29 Diabetic patients, acute myocardial infarction
 4–8, to reach within 4 hours
 Sliding scale, more insulin with left ventricular failure and bodyweight >120 % of ideal
 Capillary samples
 1–4 hourly
 1.2% of BG <3
 Mean BG 8.2 ± 1.3
[23] (1994)
 158 Diabetic patients, acute myocardial infarction
 7–10
 >15 mmol/l; bolus iv. Insulin ± 0.5–1 IU/hour depending on BG. Glucose infusion
 Venous samples. Reflolux II
 1–2 hourly
 17.7% of patients with BG <3.0 mmol/l
 Mean BG 9.2 ± 2.9 after 24 hours
[24] (1991)
 35 Diabetic patients, acute myocardial infarction
 4–8
 Sliding scale. Dextrose 5% infusion
 Glucometer II®. Capillary samples
 2–4 hourly
Mean BG 10.3 ± 2.1

Studies mentioned in the table are arranged according to patient category. Intensive care patients at the top, followed by surgical patients, divided in patients undergoing general surgery and patients undergoing cardiac surgery. The third category of patients consists of patients with an acute myocardial infarction. BG, blood glucose; IIP, insulin infusion protocol; iv, intravenous; NIDDM, noninsulin-dependent diabetes mellitus; sc, subcutaneous.

Meijering et al. Critical Care 2006 10:R19   doi:10.1186/cc3981