Skip to main content
Top
Published in: Critical Care 3/2008

01-06-2008 | Commentary

Tight glucose control: should we move from intensive insulin therapy alone to modulation of insulin and nutritional inputs?

Authors: Pierre Kalfon, Jean-Charles Preiser

Published in: Critical Care | Issue 3/2008

Login to get access

Abstract

The report by Chase and coworkers in the previous issue of Critical Care describes the implementation into clinical practice of the Specialized Relative Insulin Nutrition Table (SPRINT) for tight glycaemic control in critically ill patients. SPRINT is a simple, wheel-based system that modulates both insulin rate and nutritional inputs. It achieved a better glycaemic control in a severely ill critical cohort than their previous method for glycaemic control in a matched historical cohort. Reductions in mortality were also observed.
Literature
1.
go back to reference Chase JG, Shaw G, Le Compte A, Lonergan T, Willacy M, Wong XW, Lin J, Lotz T, Lee D, Hann C: Implementation and evaluation of the SPRINT protocol for tight glycaemic control in critically ill patients: a clinical practice change. Crit Care 2008, 12: R49. 10.1186/cc6868PubMedCentralCrossRefPubMed Chase JG, Shaw G, Le Compte A, Lonergan T, Willacy M, Wong XW, Lin J, Lotz T, Lee D, Hann C: Implementation and evaluation of the SPRINT protocol for tight glycaemic control in critically ill patients: a clinical practice change. Crit Care 2008, 12: R49. 10.1186/cc6868PubMedCentralCrossRefPubMed
2.
go back to reference Wong XW, Singh-Levett I, Hollingsworth LJ, Shaw GM, Hann CE, Lotz T, Lin J, Wong OS, Chase JG: A novel, model-based insulin and nutrition delivery controller for glycemic regulation in critically ill patients. Diabetes Technol Ther 2006, 8: 174-190. 10.1089/dia.2006.8.174CrossRefPubMed Wong XW, Singh-Levett I, Hollingsworth LJ, Shaw GM, Hann CE, Lotz T, Lin J, Wong OS, Chase JG: A novel, model-based insulin and nutrition delivery controller for glycemic regulation in critically ill patients. Diabetes Technol Ther 2006, 8: 174-190. 10.1089/dia.2006.8.174CrossRefPubMed
3.
go back to reference Wong XW, Chase JG, Shaw GM, Hann CE, Lotz T, Lin J, Singh-Levett I, Hollingsworth LJ, Wong OS, Andreassen S: Model predictive glycaemic regulation in critical illness using insulin and nutrition input: a pilot study. Med Eng Phys 2006, 28: 665-681. 10.1016/j.medengphy.2005.10.015CrossRefPubMed Wong XW, Chase JG, Shaw GM, Hann CE, Lotz T, Lin J, Singh-Levett I, Hollingsworth LJ, Wong OS, Andreassen S: Model predictive glycaemic regulation in critical illness using insulin and nutrition input: a pilot study. Med Eng Phys 2006, 28: 665-681. 10.1016/j.medengphy.2005.10.015CrossRefPubMed
4.
go back to reference Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001, 345: 1359-1367. 10.1056/NEJMoa011300CrossRefPubMed Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001, 345: 1359-1367. 10.1056/NEJMoa011300CrossRefPubMed
5.
go back to reference Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K, German Competence Network Sepsis (SepNet): Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008, 358: 125-139. 10.1056/NEJMoa070716CrossRefPubMed Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K, German Competence Network Sepsis (SepNet): Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008, 358: 125-139. 10.1056/NEJMoa070716CrossRefPubMed
6.
go back to reference Merz TM, Finfer S: Pro/con debate: is intensive insulin therapy targeting tight blood glucose control of benefit in critically ill patients? Crit Care 2008, 12: 212. 10.1186/cc6837PubMedCentralCrossRefPubMed Merz TM, Finfer S: Pro/con debate: is intensive insulin therapy targeting tight blood glucose control of benefit in critically ill patients? Crit Care 2008, 12: 212. 10.1186/cc6837PubMedCentralCrossRefPubMed
7.
go back to reference Bellomo R, Egi M: Glycemic control in the intensive care unit: why we should wait for NICE-SUGAR. Mayo Clin Proc 2005, 80: 1546-1548.CrossRefPubMed Bellomo R, Egi M: Glycemic control in the intensive care unit: why we should wait for NICE-SUGAR. Mayo Clin Proc 2005, 80: 1546-1548.CrossRefPubMed
8.
go back to reference Wilson M, Weinreb J, Hoo GW: Intensive insulin therapy in critical care: a review of 12 protocols. Diabetes Care 2007, 30: 1005-1011. 10.2337/dc06-1964CrossRefPubMed Wilson M, Weinreb J, Hoo GW: Intensive insulin therapy in critical care: a review of 12 protocols. Diabetes Care 2007, 30: 1005-1011. 10.2337/dc06-1964CrossRefPubMed
9.
go back to reference Pittas AG, Siegel RD, Lau J: Insulin therapy and in-hospital mortality in critically ill patients: systematic review and meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr 2006, 30: 164-172. 10.1177/0148607106030002164CrossRefPubMed Pittas AG, Siegel RD, Lau J: Insulin therapy and in-hospital mortality in critically ill patients: systematic review and meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr 2006, 30: 164-172. 10.1177/0148607106030002164CrossRefPubMed
10.
go back to reference Vogelzang M, Horst IC, Nijsten MW: Hyperglycaemic index as a tool to assess glucose control: a retrospective study. Crit Care 2004, 8: R122-R127. 10.1186/cc2840PubMedCentralCrossRefPubMed Vogelzang M, Horst IC, Nijsten MW: Hyperglycaemic index as a tool to assess glucose control: a retrospective study. Crit Care 2004, 8: R122-R127. 10.1186/cc2840PubMedCentralCrossRefPubMed
11.
go back to reference Van Herpe T, De Brabanter J, Beullens M, De Moor B, Berghe G: Glycemic penalty index for adequately assessing and comparing different blood glucose control algorithms. Crit Care 2008, 12: R24. 10.1186/cc6800PubMedCentralCrossRefPubMed Van Herpe T, De Brabanter J, Beullens M, De Moor B, Berghe G: Glycemic penalty index for adequately assessing and comparing different blood glucose control algorithms. Crit Care 2008, 12: R24. 10.1186/cc6800PubMedCentralCrossRefPubMed
12.
go back to reference Egi M, Bellomo R, Stachowski E, French CJ, Hart G: Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology 2006, 105: 244-252. 10.1097/00000542-200608000-00006CrossRefPubMed Egi M, Bellomo R, Stachowski E, French CJ, Hart G: Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology 2006, 105: 244-252. 10.1097/00000542-200608000-00006CrossRefPubMed
13.
go back to reference Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R: Intensive insulin therapy in the medical ICU. N Engl J Med 2006, 354: 449-461. 10.1056/NEJMoa052521CrossRefPubMed Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R: Intensive insulin therapy in the medical ICU. N Engl J Med 2006, 354: 449-461. 10.1056/NEJMoa052521CrossRefPubMed
15.
go back to reference Hovorka R, Kremen J, Blaha J, Matias M, Anderlova K, Bosanska L, Roubicek T, Wilinska ME, Chassin LJ, Svacina S, Haluzik M: Blood glucose control by a model predictive control algorithm with variable sampling rate versus a routine glucose management protocol in cardiac surgery patients: a randomized controlled trial. J Clin Endocrinol Metab 2007, 92: 2960-2964. 10.1210/jc.2007-0434CrossRefPubMed Hovorka R, Kremen J, Blaha J, Matias M, Anderlova K, Bosanska L, Roubicek T, Wilinska ME, Chassin LJ, Svacina S, Haluzik M: Blood glucose control by a model predictive control algorithm with variable sampling rate versus a routine glucose management protocol in cardiac surgery patients: a randomized controlled trial. J Clin Endocrinol Metab 2007, 92: 2960-2964. 10.1210/jc.2007-0434CrossRefPubMed
Metadata
Title
Tight glucose control: should we move from intensive insulin therapy alone to modulation of insulin and nutritional inputs?
Authors
Pierre Kalfon
Jean-Charles Preiser
Publication date
01-06-2008
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2008
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc6915

Other articles of this Issue 3/2008

Critical Care 3/2008 Go to the issue