Dataset Information

Variability of insulin sensitivity during the first 4?days of critical illness: implications for tight glycemic control.

ABSTRACT:

Background

Effective tight glycemic control (TGC) can improve outcomes in critical care patients, but it is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between insulin concentration and insulin-mediated glucose disposal. Hence, variability of insulin sensitivity can cause variable glycemia. This study quantifies and compares the daily evolution of insulin sensitivity level and variability for critical care patients receiving TGC.

Methods

This is a retrospective analysis of data from the SPRINT TGC study involving patients admitted to a mixed medical-surgical ICU between August 2005 and May 2007. Only patients who commenced TGC within 12 hours of ICU admission and spent at least 24 hours on the SPRINT protocol were included (N?=?164). Model-based insulin sensitivity (SI) was identified each hour. Absolute level and hour-to-hour percent changes in SI were assessed on cohort and per-patient bases. Levels and variability of SI were compared over time on 24-hour and 6-hour timescales for the first 4?days of ICU stay.

Results

Cohort and per-patient median SI levels increased by 34% and 33% (p?ConclusionsCritically ill patients have significantly lower and more variable insulin sensitivity on day 1 than later in their ICU stay and particularly during the first 12 hours. This rapid improvement is likely due to the decline of counter-regulatory hormones as the acute phase of critical illness progresses. Clinically, these results suggest that while using TGC protocols with patients during their first few days of ICU stay, extra care should be afforded. Increased measurement frequency, higher target glycemic bands, conservative insulin dosing, and modulation of carbohydrate nutrition should be considered to minimize safely the outcome glycemic variability and reduce the risk of hypoglycemia.

SUBMITTER: Pretty CG

PROVIDER: S-EPMC3464183 | biostudies-literature | 2012 Jun

REPOSITORIES: biostudies-literature

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Variability of insulin sensitivity during the first 4 days of critical illness: implications for tight glycemic control.

Pretty Christopher G CG Le Compte Aaron J AJ Chase J Geoffrey JG Shaw Geoffrey M GM Preiser Jean-Charles JC Penning Sophie S Desaive Thomas T

Annals of intensive care 20120615 1

<h4>Background</h4>Effective tight glycemic control (TGC) can improve outcomes in critical care patients, but it is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between insulin concentration and insulin-mediated glucose disposal. Hence, variability of insulin sensitivity can cause variable glycemia. This study quantifies and compares the daily evolution of insulin sensitivity level and variability for critical care patients receiving TGC.<h4>Methods</h4>Th ...[more]

PMID: 22703645

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