Diabetes
Conditions
Keywords
postoperative blood glucose control, IV insulin infusion
Brief summary
The investigators are testing whether a written protocol or a computerized program can more effectively control blood glucose after surgery.
Detailed description
In 2002 we adapted the protocol described by Van den Berghe et al. for use in our own surgical intensive care unit (SICU) with a target blood glucose range from 80 to 120mg/dL. After five years of implementation, we were able to achieve a mean BG of 117 mg/dL in the SICU. 2% of glucose values were \<60 mg/dL in the SICU. Given the concern of safety while optimizing glycemic control, we investigated the etiologies for these hypoglycemic episodes and have found two frequent risk factors; the failure to consistently measure blood glucose every hour and in patients with end stage renal failure. We will investigate whether a computer-based algorithm for the titration of IV insulin will translate to better clinical outcomes and less hypoglycemia. Therefore, we will conduct a prospective randomized trial comparing the Glucommander, a computer-based algorithm with our Van den Berghe protocol for titration of IV insulin in patients after cardiovascular or transplant surgery. This computer based algorithm was invented in 1984 in Atlanta by Dr. Davidson and Dr. Steed who have used it in a variety of applications of IV insulin.
Interventions
DRUGinsulin regular IV infusion
IV insulin was administered by continuous infusion and the rate changed every hour according to the blood glucose level as determined by each of the protocols being compared
IV insulin was administered by continuous infusion and the rate changed every hour according to the blood glucose level as determined by each of the protocols being compared
Sponsors
Rush University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* s/p open heart or kidney or liver transplant surgery
Exclusion criteria
* admission blood glucose less than 120 mg/dl
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percent of blood glucose values in the target range 80-120 mg/dl | first 200 hours post-op in the ICU |
Secondary
| Measure | Time frame |
|---|---|
| Percent of patient days with a low blood glucose, defines as less than 60 mg/dl | 200 hours while in ICU |
Countries
United States
Outcome results
None listed