Pilot study of the SPRINT glycemic control protocol in a Hungarian medical intensive care unit

Balazs Benyo, Attila Illyés, Noémi Szabó Némedi, Aaron J. Le Compte, Attila Havas, L. Kovács, Liam Fisk, Geoffrey M. Shaw, J. Geoffrey Chase

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Stress-induced hyperglycemia increases morbidity and mortality. Tight control can reduce mortality but has proven difficult to achieve. The SPRINT (Specialized Relative Insulin and Nutrition Tables) protocol is the only protocol that reduced both mortality and hypoglycemia by modulating both insulin and nutrition, but it has not been tested in independent hospitals. Methods: SPRINT was used for 12 adult intensive care unit patients (949 h) at Kálmán Pándy Hospital (Gyula, Hungary) as a clinical practice assessment. Insulin recommendations (0-6 U/h) were administered via constant infusion rather than bolus delivery. Nutrition was administered per local standard protocol, weaning parenteral to enteral nutrition, but was modulated per SPRINT recommendations. Measurement was every 1 to 2 h, per protocol. Glycemic performance is assessed by percentage of blood glucose (BG) measurements in glycemic bands for the cohort and per patient. Safety from hypoglycemia is assessed by numbers of patients with BG <2.2 (severe) and %BG <3.0 and <4.0 mmol/liter (moderate and light). Clinical effort is assessed by measurements per day. Results are median (interquartile range). Results: There were 742 measurements over 1088 h of control (16.4 measurements/day), which is similar to clinical SPRINT results (16.2/day). Per-patient hours of control were 65 (50-95) h. Initial per-patient BG was 10.5 (7.9-11.2) mmol/liter. All patients (100%) reached 6.1 mmol/liter. Cohort BG was 6.3 (5.5-7.5) mmol/liter, with 42.2%, 65.1% and 77.6% of BG in the 4.0-6.1, 4.0-7.0, and 4.0-8.0 mmol/liter bands. Per-patient, median percentage time in these bands was 40.2 (26.7-51.5)%, 62.5 (46.0-75.7)%, and 74.7 (61.6.8-87.8)%, respectively. No patients had BG <2.2 mmol/liter, and the %BG <4.0 mmol/liter was 1.9%. These results were achieved using 3.0 (3.0-5.0) U/h of insulin with 7.4 (4.4-10.2) g/h of dextrose administration (all sources) for the cohort. Per-patient median insulin administration was 3.0 (3.0-3.0) U/h and 7.1 (3.4-9.6) g/h dextrose. Higher carbohydrate nutrition formulas than were used in SPRINT are offset by slightly higher insulin administration in this study. Conclusions: The glycemic performance shows that using the SPRINT protocol to guide insulin infusions and nutrition administration provided very good glycemic control in initial pilot testing, with no severe hypoglycemia. The overall design of the protocol was able to be generalized with good compliance and outcomes across geographically distinct clinical units, patients, and clinical practice.

Original languageEnglish
Pages (from-to)1464-1477
Number of pages14
JournalJournal of diabetes science and technology
Volume6
Issue number6
DOIs
Publication statusPublished - 2012

Fingerprint

Intensive care units
Insulin
Nutrition
Intensive Care Units
Glucose
Blood Glucose
Blood
Hypoglycemia
Dextrose
Mortality
Hungary
Enteral Nutrition
Carbohydrates
Weaning
Hyperglycemia

Keywords

  • Blood glucose
  • Critical care
  • Hyperglycemia
  • Insulin
  • Intensive care unit
  • SPRINT

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Bioengineering
  • Biomedical Engineering

Cite this

Pilot study of the SPRINT glycemic control protocol in a Hungarian medical intensive care unit. / Benyo, Balazs; Illyés, Attila; Némedi, Noémi Szabó; Le Compte, Aaron J.; Havas, Attila; Kovács, L.; Fisk, Liam; Shaw, Geoffrey M.; Chase, J. Geoffrey.

In: Journal of diabetes science and technology, Vol. 6, No. 6, 2012, p. 1464-1477.

Research output: Contribution to journalArticle

Benyo, B, Illyés, A, Némedi, NS, Le Compte, AJ, Havas, A, Kovács, L, Fisk, L, Shaw, GM & Chase, JG 2012, 'Pilot study of the SPRINT glycemic control protocol in a Hungarian medical intensive care unit', Journal of diabetes science and technology, vol. 6, no. 6, pp. 1464-1477. https://doi.org/10.1177/193229681200600628
Benyo, Balazs ; Illyés, Attila ; Némedi, Noémi Szabó ; Le Compte, Aaron J. ; Havas, Attila ; Kovács, L. ; Fisk, Liam ; Shaw, Geoffrey M. ; Chase, J. Geoffrey. / Pilot study of the SPRINT glycemic control protocol in a Hungarian medical intensive care unit. In: Journal of diabetes science and technology. 2012 ; Vol. 6, No. 6. pp. 1464-1477.
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keywords = "Blood glucose, Critical care, Hyperglycemia, Insulin, Intensive care unit, SPRINT",
author = "Balazs Benyo and Attila Illy{\'e}s and N{\'e}medi, {No{\'e}mi Szab{\'o}} and {Le Compte}, {Aaron J.} and Attila Havas and L. Kov{\'a}cs and Liam Fisk and Shaw, {Geoffrey M.} and Chase, {J. Geoffrey}",
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TY - JOUR

T1 - Pilot study of the SPRINT glycemic control protocol in a Hungarian medical intensive care unit

AU - Benyo, Balazs

AU - Illyés, Attila

AU - Némedi, Noémi Szabó

AU - Le Compte, Aaron J.

AU - Havas, Attila

AU - Kovács, L.

AU - Fisk, Liam

AU - Shaw, Geoffrey M.

AU - Chase, J. Geoffrey

PY - 2012

Y1 - 2012

N2 - Introduction: Stress-induced hyperglycemia increases morbidity and mortality. Tight control can reduce mortality but has proven difficult to achieve. The SPRINT (Specialized Relative Insulin and Nutrition Tables) protocol is the only protocol that reduced both mortality and hypoglycemia by modulating both insulin and nutrition, but it has not been tested in independent hospitals. Methods: SPRINT was used for 12 adult intensive care unit patients (949 h) at Kálmán Pándy Hospital (Gyula, Hungary) as a clinical practice assessment. Insulin recommendations (0-6 U/h) were administered via constant infusion rather than bolus delivery. Nutrition was administered per local standard protocol, weaning parenteral to enteral nutrition, but was modulated per SPRINT recommendations. Measurement was every 1 to 2 h, per protocol. Glycemic performance is assessed by percentage of blood glucose (BG) measurements in glycemic bands for the cohort and per patient. Safety from hypoglycemia is assessed by numbers of patients with BG <2.2 (severe) and %BG <3.0 and <4.0 mmol/liter (moderate and light). Clinical effort is assessed by measurements per day. Results are median (interquartile range). Results: There were 742 measurements over 1088 h of control (16.4 measurements/day), which is similar to clinical SPRINT results (16.2/day). Per-patient hours of control were 65 (50-95) h. Initial per-patient BG was 10.5 (7.9-11.2) mmol/liter. All patients (100%) reached 6.1 mmol/liter. Cohort BG was 6.3 (5.5-7.5) mmol/liter, with 42.2%, 65.1% and 77.6% of BG in the 4.0-6.1, 4.0-7.0, and 4.0-8.0 mmol/liter bands. Per-patient, median percentage time in these bands was 40.2 (26.7-51.5)%, 62.5 (46.0-75.7)%, and 74.7 (61.6.8-87.8)%, respectively. No patients had BG <2.2 mmol/liter, and the %BG <4.0 mmol/liter was 1.9%. These results were achieved using 3.0 (3.0-5.0) U/h of insulin with 7.4 (4.4-10.2) g/h of dextrose administration (all sources) for the cohort. Per-patient median insulin administration was 3.0 (3.0-3.0) U/h and 7.1 (3.4-9.6) g/h dextrose. Higher carbohydrate nutrition formulas than were used in SPRINT are offset by slightly higher insulin administration in this study. Conclusions: The glycemic performance shows that using the SPRINT protocol to guide insulin infusions and nutrition administration provided very good glycemic control in initial pilot testing, with no severe hypoglycemia. The overall design of the protocol was able to be generalized with good compliance and outcomes across geographically distinct clinical units, patients, and clinical practice.

AB - Introduction: Stress-induced hyperglycemia increases morbidity and mortality. Tight control can reduce mortality but has proven difficult to achieve. The SPRINT (Specialized Relative Insulin and Nutrition Tables) protocol is the only protocol that reduced both mortality and hypoglycemia by modulating both insulin and nutrition, but it has not been tested in independent hospitals. Methods: SPRINT was used for 12 adult intensive care unit patients (949 h) at Kálmán Pándy Hospital (Gyula, Hungary) as a clinical practice assessment. Insulin recommendations (0-6 U/h) were administered via constant infusion rather than bolus delivery. Nutrition was administered per local standard protocol, weaning parenteral to enteral nutrition, but was modulated per SPRINT recommendations. Measurement was every 1 to 2 h, per protocol. Glycemic performance is assessed by percentage of blood glucose (BG) measurements in glycemic bands for the cohort and per patient. Safety from hypoglycemia is assessed by numbers of patients with BG <2.2 (severe) and %BG <3.0 and <4.0 mmol/liter (moderate and light). Clinical effort is assessed by measurements per day. Results are median (interquartile range). Results: There were 742 measurements over 1088 h of control (16.4 measurements/day), which is similar to clinical SPRINT results (16.2/day). Per-patient hours of control were 65 (50-95) h. Initial per-patient BG was 10.5 (7.9-11.2) mmol/liter. All patients (100%) reached 6.1 mmol/liter. Cohort BG was 6.3 (5.5-7.5) mmol/liter, with 42.2%, 65.1% and 77.6% of BG in the 4.0-6.1, 4.0-7.0, and 4.0-8.0 mmol/liter bands. Per-patient, median percentage time in these bands was 40.2 (26.7-51.5)%, 62.5 (46.0-75.7)%, and 74.7 (61.6.8-87.8)%, respectively. No patients had BG <2.2 mmol/liter, and the %BG <4.0 mmol/liter was 1.9%. These results were achieved using 3.0 (3.0-5.0) U/h of insulin with 7.4 (4.4-10.2) g/h of dextrose administration (all sources) for the cohort. Per-patient median insulin administration was 3.0 (3.0-3.0) U/h and 7.1 (3.4-9.6) g/h dextrose. Higher carbohydrate nutrition formulas than were used in SPRINT are offset by slightly higher insulin administration in this study. Conclusions: The glycemic performance shows that using the SPRINT protocol to guide insulin infusions and nutrition administration provided very good glycemic control in initial pilot testing, with no severe hypoglycemia. The overall design of the protocol was able to be generalized with good compliance and outcomes across geographically distinct clinical units, patients, and clinical practice.

KW - Blood glucose

KW - Critical care

KW - Hyperglycemia

KW - Insulin

KW - Intensive care unit

KW - SPRINT

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