Inpatient hyperglycemia is associated with prolonged hospital length of stay (LOS) and morbidity. Minimizing both hypo and hyperglycemic events are an overall strategy to avoid hospital complications related to dysglycemia. Diabetic ketoacidosis (DKA) and stress related hyperglycemia are frequently managed in the critical care setting with IV insulin where guidelines recommend a blood glucose (BG) target of 140 - 180 mg/dL. Best practices regarding optimal BG targets in critical care settings are evolving. The EndoTool IV (ETIV) de-identified data base was studied for glycemic events as a function of BG ranges. ETIV is an insulin dosing algorithm that utilizes patient factors to adjust insulin dosing and allows selection of target BG values. For the calendar year 2023 73,458 patient runs with IV insulin were studied. Target BG ranges fell into 4 major groups as shown in Table 1. No significant differences in number of BG checks, use of steroids or renal function was noted among the groups. There are statistically significant differences in hypoglycemia between target ranges compared to BG 140-180.These data suggest that for a heterogeneous patient population treated with IV insulin 120-160 mg/dL offers minimal hypoglycemic and hyperglycemic events with acceptable time in goal range.
Table 1: BG target ranges mg/dL with event rates for hyper and hypoglycemia and relative risk (RR) for hypoglycemia compared to 140-180 BG
J. Aloi: Research Support; Abbott, Medtronic. C.E. Price: Other Relationship; American Diabetes Association.
