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Abstract

Background: Diabetic patients with acute coronary syndromes (ACS) might benefit from tight glycemic control by means of insulin infusion. Nurse-implemented insulin infusion protocols (IIP) are available but none validated in patients with ACS admitted to a coronary care unit (CCU).

Aims: To assess feasibility, effectiveness and safety of a new nurse-managed IIP (Desio Diabetes Diagram, DDD) for intensive glucose control in patients with suspected ACS and known diabetes or blood glucose (BG) > 200 mg/dL.

Methods and results: To reach and maintain a target BG level of 100–139 mg/dL we adopted a nomogram based on the percent changes in the insulin infusion rate according to the current BG value and the percent change from previous BG level.

Ninety-one consecutive patients (53 men, mean age 69.7 ± 11.2 years) were treated with DDD IIP. Baseline BG was 202.2 ± 86.8 mg/dL. The median time to achieve the target was 3 h (Q1–Q3 2–5 h). Afterwards target BG levels were maintained for 70.4 ± 15.9% of the time. During 5004 h of insulin infusion BG never fell below 40 mg/dL.

Conclusions: The nurse-managed DDD IIP was easily implemented in our CCU and permitted strict and safe glycemic control in hyperglycemic patients with ACS.

Keywords

Acute coronary syndrome Diabetes Hypoglycemia Glucose variability Insulin infusion

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References

[1]

Deedwania

Kosiborod

Barrett

Ceriello

Isley

Mazzone

Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism

Circulation 117 2008 1610–1619

[2]

Malmberg

Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group

BMJ 314 1997 1512–1515

[3]

Cheung

N.W.

Wong

V.W.

McLean

The hyperglycemia intensive insulin infusion in infarction (HI-5) Study. A randomized controlled trial of insulin infusion therapy for myocardial infarction

Diabetes Care 29 2006 765–770

[4]

Langley

Adams

Insulin-based regimens decrease mortality rates in critically ill patients: a systematic review

Diabetes Metab Res Rev 23 2007 184–192

[5]

American Diabetes Association

Standards of Medical Care in Diabetes — 2008

Diabetes Care 31 supplement 1 2008 S12–S54

[6]

The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)

Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary

Eur Heart J 28 2007 88–136

[7]

Krinsley

J.S.

Grover

Severe hypoglycemic in critically ill patients: risk factors and outcomes

Crit Care Med 35 2007 2262–2267

[8]

Vanhorebeek

Langouche

Van den Berghe

Tight blood glucose control with insulin in the ICU: facts and controversies

Chest 132 2007 268–278

[9]

Krinsley

Glycemic control in critically ill patients. Leuven and beyond

Chest 132 2007 1–2

10.

[10]

Nasraway

S.A.

Sitting on the horns of a dilemma: avoiding severe hypoglycemia while practicing tight glycemic control

Crit Care Med 35 2007 2435–2437

11.

[11]

Meijering

Corstjens

A.M.

Tulleken

J.E.

Meertens

J.H.

Zijlstra

J.G.

Ligtenberg

J.M.

Towards a feasible algorithm for tight glycemic control in critically ill patients: a systematic review of literature

Crit Care 10 2006 1–7

12.

[12]

Nazer

L.H.

Chow

S.L.

Moghissi

E.S.

Insulin infusion protocols for critically ill patients: a highlight of differences and similarities

Endocr Pract 13 2007 137–146

13.

[13]

Goldberg

P.A.

Siegel

M.D.

Sherwin

R.S.

Halickman

J.I.

Lee

Bailey

V.A.

Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit

Diabetes Care 27 2004 461–467

14.

[14]

Kanji

Singh

Tierney

Meggison

McIntyre

Hebert

P.C.

Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults

Intensive Care Med 30 2004 804–810

15.

[15]

Laver

Preston

Turner

McKinstry

Padkin

Implementing intensive insulin therapy: development and audit of the Bath insulin protocol

Anaesth Intensive Care 32 2004 311–316

16.

[16]

Krinsley

J.S.

Effect of an intensive glucose management protocol on the mortality of critically ill patients

Mayo Clin Proc 79 2004 992–1000 Erratum in Mayo Clin Proc 2005;80:1101

17.

[17]

Goldberg

P.A.

Roussel

M.G.

Inzucchi

S.E.

Clinical results of an updated insulin infusion protocol in critically ill patients

Diabetes Spectr 18 2005 188–191

18.

[18]

Chant

Wilson

Friedrich

J.O.

Validation of an insulin infusion nomogram for intensive glucose control in critically ill patients

Pharmacotherapy 25 2005 352–359

19.

[19]

Quinn

J.A.

Snyder

S.L.

Berghoff

J.L.

Colombo

C.S.

Jacobi

A practical approach to hyperglycemia management in the intensive care unit: evaluation of an intensive insulin infusion protocol

Pharmacotherapy 26 2006 1410–1420

20.

[20]

Lonergan

Compte

A.L.

Willacy

Chase

J.G.

Shaw

G.M.

Hann

C.E.

A pilot study of the SPRINT protocol for tight glycemic control in critically ill patients

Diabetes Technol Ther 8 2006 449–462

21.

[21]

Clayton

S.B.

Mazur

J.E.

Condren

Hermayer

K.L.

Strange

Evaluation of an intensive insulin protocol for septic patients in a medical intensive care unit

Crit Care Med 34 2006 2974–2978

22.

[22]

Balkin

Mascioli

Smith

Alnachawati

Mehrishi

Saydain

Achieving durable glucose control in the intensive care unit without hypoglycemia: a new practical IV insulin protocol

Diabetes Metab Res Rev 23 2007 49–55

23.

[23]

McMullin

Brożek

McDonald

Clarke

Jaeschke

Heels-Ansdell

Lowering of glucose in critical care: a randomized pilot trial

J Crit Care 22 2007 112–119

24.

[24]

Alm-Kruse

Bull

E.M.

Laake

J.H.

Nurse-led implementation of an insulin–infusion protocol in a general intensive care unit: improved glycemic control with increased costs and risk of hypoglycemia signals need for algorithm revision

BMC Nursing 7 2008 1–10

25.

[25]

Avanzini

Marelli

Donzelli

Sorbara

Palazzo

Bellato

Protocollo di infusione di insulina a gestione infermieristica per il controllo intensivo della glicemia. Esperienza pilota in pazienti diabetici con sindrome coronarica acuta.(Nurse-implemented insulin infusion protocol for intensive glucose control: pilot experience in diabetic patients with acute coronary sindrome)

G It Diabetol Metab 27 2007 202–211

Hyperglycemia During Acute Coronary Syndrome: A Nurse-Managed Insulin Infusion Protocol for Stricter and Safer Control

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