LAUSR

Aims To evaluate the efficacy and safety of a modified insulin infusion protocol, targeting a blood glucose level of 140–180 mg/dL, in a medical intensive care unit at a tertiary care university hospital. Methods We compared glycemic control parameters before and after using the KCMH insulin infusion protocol in a MICU (pre- and post-protocol groups). In the pre-protocol group, hyperglycemia was managed by conventional care. In the post-protocol group, hyperglycemia was managed according to the KCMH protocol. Study outcomes were a proportion of patients achieving a glycemic target of 140–180 mg/dL within 8 h after initiation of an insulin infusion, various glycemic control parameters, and clinical outcomes. Result Twenty-eight patients were in the pre-protocol group, and 27 were in the post-protocol group. The proportion of patients achieving a glycemic target within 8 h after initiation of an insulin infusion was significantly higher in the post-protocol group compared to the pre-protocol group (70.4% vs. 21.4%, p  < 0.001). Patients in the post-protocol group achieved a blood glucose target faster than the pre-protocol group (7.4 ± 4.1 h vs. 12.5 ± 7.5 h, p  = 0.004). Mean blood glucose levels during insulin infusion were significantly lower in the post-protocol group compared to the pre-protocol group (170.9 ± 15.3 mg/dL vs. 205.6 ± 46.7 mg/dL, p  = 0.001). The glycemic variability indices were also better in the post-protocol group. Conclusion Implementation of a KCMH insulin infusion protocol in a medical ICU resulted in better glycemic control than conventional care without excess risk of hypoglycemia. Trial registration The study was approved by the Institutional Review Board and Thai Clinical Trial Registry ( clinicaltrials.in.th : TCTR20161105001).