Evaluation of effectiveness and safety of an ICU insulin infusion protocol / Journal of the ASEAN Federation of Endocrine Societies

ABSTRACT

Objective@#To evaluate the efficacy, safety, and clinical outcomes of, and protocol deviations with the use of the Modified Yale Insulin Infusion Protocol (IIP) compared to usual/standard care in the local setting. @*Methods@#Chart review of patients admitted in two ICUs over a 2-year period was done. Patients eligible for intensive glycemic control were identified. Efficacy, safety and clinical outcomes were compared between the Modified Yale IIP and usual/standard care. Charts managed with the IIP were appraised for protocol deviations.@*Results@#Eighty-one patients met the inclusion criteria and 34.6% used the IIP. The IIP group achieved a lower mean blood glucose (185.1 vs 212.1 mg/dl, p<0.05). They reached normoglycemia (5 vs 12 hours, p<0.05) and target range of 140-180 mg/dl (8.3 vs 18.3 hours, p<0.05) earlier. Hypoglycemia was rare (median 0%) in both groups. No difference in mortality or morbidity was seen. Hospital (13.9 vs 8.1 days, p<0.05) and ICU stay (5.5 vs 3.0 days, p<0.05) were longer in the IIP group. A mean of 11 deviations per patient occurred, the majority of which were errors on insulin dose administered (66.6%). @*Conclusion@#The Modified Yale IIP is efficaceous, safe and yielded better glycemic profiles than usual care. Majority of protocol deviations were on the insulin dose administered