{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T22:03:32Z","timestamp":1791151412961,"version":"4.1.0"},"reference-count":22,"publisher":"American Diabetes Association","issue":"2","content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2004,2,1]]},"abstract":"<jats:p>OBJECTIVE\u2014In a recent randomized controlled trial, lowering blood glucose levels to 80\u2013110 mg\/dl improved clinical outcomes in critically ill patients. In that study, the insulin infusion protocol (IIP) used to normalize blood glucose levels provided valuable guidelines for adjusting insulin therapy. In our hands, however, ongoing expert supervision was required to effectively manage the insulin infusions. This work describes our early experience with a safe, effective, nurse-implemented IIP that provides detailed insulin dosing instructions and requires minimal physician input.<\/jats:p>\n               <jats:p>RESEARCH DESIGN AND METHODS\u2014We collected data from 52 medical intensive care unit (MICU) patients who were placed on the IIP. Blood glucose levels were the primary outcome measurement. Relevant clinical variables and insulin requirements were also recorded. MICU nurses were surveyed regarding their experience with the IIP.<\/jats:p>\n               <jats:p>RESULTS\u2014To date, our IIP has been employed 69 times in 52 patients admitted to an MICU. Using the IIP, the median time to reach target blood glucose levels (100\u2013139 mg\/dl) was 9 h. Once blood glucose levels fell below 140 mg\/dl, 52% of 5,808 subsequent hourly blood glucose values fell within our narrow target range; 66% within a \u201cclinically desirable\u201d range of 80\u2013139 mg\/dl; and 93% within a \u201cclinically acceptable\u201d range of 80\u2013199 mg\/dl. Only 20 (0.3%) blood glucose values were &amp;lt;60 mg\/dl, none of which resulted in clinically significant adverse events. In general, the IIP was readily accepted by our MICU nursing staff, most of whom rated the protocol as both clinically effective and easy to use.<\/jats:p>\n               <jats:p>CONCLUSIONS\u2014Our nurse-implemented IIP is safe and effective in improving glycemic control in critically ill patients.<\/jats:p>","DOI":"10.2337\/diacare.27.2.461","type":"journal-article","created":{"date-parts":[[2007,3,5]],"date-time":"2007-03-05T22:51:27Z","timestamp":1173135087000},"page":"461-467","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":384,"title":["Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit"],"prefix":"10.2337","volume":"27","author":[{"given":"Philip A.","family":"Goldberg","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Section of Endocrinology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Siegel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Pulmonary & Critical Care, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Sherwin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Endocrinology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua I.","family":"Halickman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Endocrinology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Endocrinology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie A.","family":"Bailey","sequence":"additional","affiliation":[{"name":"Department of Nursing, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandy L.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Nursing, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Dziura","sequence":"additional","affiliation":[{"name":"General Clinical Research Center, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio E.","family":"Inzucchi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Endocrinology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","reference":[{"key":"2022031219015801200_R1","doi-asserted-by":"crossref","unstructured":"Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in critically ill patients. N Engl J Med\u2008345:1359\u20131367, 2001","DOI":"10.1056\/NEJMoa011300"},{"key":"2022031219015801200_R2","doi-asserted-by":"crossref","unstructured":"Malmberg K, Ryden L, Efendic S, Herlitz J, Nicol P, Waldenstrom A, Wedel H, Welin L: Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol\u200826:57\u201365, 1995","DOI":"10.1016\/0735-1097(95)00126-K"},{"key":"2022031219015801200_R3","doi-asserted-by":"crossref","unstructured":"Malmberg K, DIGAMI Study Group: Prospective randomised study of intensive insulin treatment on long-term survival after acute myocardial infarction in patients with diabetes mellitus. Br Med J\u2008314:1512\u20131515, 1997","DOI":"10.1136\/bmj.314.7093.1512"},{"key":"2022031219015801200_R4","doi-asserted-by":"crossref","unstructured":"Furnary AP, Zerr KJ, Grunkemeier GL, Starr A: Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg\u200867:352\u2013362, 1999","DOI":"10.1016\/S0003-4975(99)00014-4"},{"key":"2022031219015801200_R5","doi-asserted-by":"crossref","unstructured":"Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med\u200813:818\u2013829, 1985","DOI":"10.1097\/00003246-198510000-00009"},{"key":"2022031219015801200_R6","unstructured":"Inzucchi SE, Goldberg PA, Dziura JD, Siegel M, Lee M, Halickman J, Sherwin R: Risk factors for poor glycemic control in a medical intensive care unit (ICU) (Abstract). Diabetes\u200852(Suppl. 1):A96, 2003"},{"key":"2022031219015801200_R7","doi-asserted-by":"crossref","unstructured":"Mizrock BA: Alterations in carbohydrate metabolism during stress: a review of the literature. Am J Med\u200898:75\u2013107, 1995","DOI":"10.1016\/S0002-9343(99)80083-7"},{"key":"2022031219015801200_R8","doi-asserted-by":"crossref","unstructured":"Malmberg K, Norhammar A, Wedel H, Ryden L: Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes and acute myocardial infarction. Circulation\u200899:2626\u20132632, 1999","DOI":"10.1161\/01.CIR.99.20.2626"},{"key":"2022031219015801200_R9","doi-asserted-by":"crossref","unstructured":"Capes SE, Hunt D, Malmberg K, Gerstain HC: Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet\u2008355:773\u2013778, 2000","DOI":"10.1016\/S0140-6736(99)08415-9"},{"key":"2022031219015801200_R10","doi-asserted-by":"crossref","unstructured":"Wahab NN, Cowden EA, Pearce NJ, Gardner MJ, Merry H, Cox JL, ICONS Investigators: Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am Coll Cardiol\u200840:1748\u20131754, 2002","DOI":"10.1016\/S0735-1097(02)02483-X"},{"key":"2022031219015801200_R11","doi-asserted-by":"crossref","unstructured":"Gray CS, Taylor R, French JM, Alberti KG, Venables GS, James OF, Shaw DA, Cartlidge NE, Bates D: The prognostic value of stress hyperglycaemia and previously unrecognized diabetes mellitus in acute stroke. Diabet Med\u20084:237\u2013240, 1987","DOI":"10.1111\/j.1464-5491.1987.tb00870.x"},{"key":"2022031219015801200_R12","doi-asserted-by":"crossref","unstructured":"Woo J, Lam CW, Kay R, Wong AH, Teoh R, Nicholls MG: The influence of hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol\u200847:1174\u20131177, 1990","DOI":"10.1001\/archneur.1990.00530110028011"},{"key":"2022031219015801200_R13","doi-asserted-by":"crossref","unstructured":"Parsons MW, Barber PA, Desmond PA, Baird TA, Darby DG, Byrnes G, Tress BM, Davis SM: Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance and spectroscopy study. Ann Neurol\u200852:20\u201328, 2002","DOI":"10.1002\/ana.10241"},{"key":"2022031219015801200_R14","doi-asserted-by":"crossref","unstructured":"Williams LS, Rotich J, Qi R, Fineberg N, Espay A, Bruno A, Fineberg SE, Tierney WR: Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology\u200859:67\u201371, 2002","DOI":"10.1212\/WNL.59.1.67"},{"key":"2022031219015801200_R15","doi-asserted-by":"crossref","unstructured":"Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE: Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab\u200887:978\u2013982, 2002","DOI":"10.1210\/jcem.87.3.8341"},{"key":"2022031219015801200_R16","doi-asserted-by":"crossref","unstructured":"Preiser J-C, Devos P, Van den Berghe G: Tight control of glycaemia in critically ill patients. Curr Opin Clin Nutr Metab Care\u20085:533\u2013537, 2002","DOI":"10.1097\/00075197-200209000-00012"},{"key":"2022031219015801200_R17","doi-asserted-by":"crossref","unstructured":"Oliver MF, Opie LH: Effects of glucose and fatty acids on myocardial ischaemia and arrythmias. Lancet\u2008343:155\u2013158, 1994","DOI":"10.1016\/S0140-6736(94)90939-3"},{"key":"2022031219015801200_R18","doi-asserted-by":"crossref","unstructured":"Trence DL, Kelly JL, Hirsch IB: The rationale and management of hyperglycemia for in-patients with cardiovascular disease: time for change. J Clin Endocrinol Metab\u200888:2430\u20132437, 2003","DOI":"10.1210\/jc.2003-030347"},{"key":"2022031219015801200_R19","doi-asserted-by":"crossref","unstructured":"Dandona P, Aljada A, Bandyopadhyay A: The potential therapeutic role of insulin in acute myocardial infarction in patients admitted to intensive care and in those with unspecified hyperglycemia. Diabetes Care\u200826:516\u2013519, 2003","DOI":"10.2337\/diacare.26.2.516"},{"key":"2022031219015801200_R20","unstructured":"Ousman YH, Sharma MB, Ringel MD, Walker SM, Magee MF: A standardized nurse-adjusted insulin infusion algorithm (SIIA) is safe and effective (Abstract). Diabetes\u200851(Suppl. 2):A110, 2002"},{"key":"2022031219015801200_R21","doi-asserted-by":"crossref","unstructured":"Markovitz LJ, Wiechmann RJ, Harris N, Hayden V, Cooper J, Johnson G, Harelstad R, Calkins L, Braithwaite SS: Description and evaluation of a glycemic management protocol for patients with diabetes undergoing heart surgery. Endocr Pract\u20088:10\u201318, 2002","DOI":"10.4158\/EP.8.1.10"},{"key":"2022031219015801200_R22","unstructured":"Lien L, Spratt S, Woods Z, Osborne K, Feinglos M: A new intravenous insulin normogram in intensive care units improves management of persistent hyperglycemia (Abstract). Diabetes\u200852(Suppl. 1):A125, 2003"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/27\/2\/461\/661149\/zdc00204000461.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/27\/2\/461\/661149\/zdc00204000461.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T20:17:00Z","timestamp":1647116220000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/27\/2\/461\/28348\/Implementation-of-a-Safe-and-Effective-Insulin"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,2,1]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2004,2,1]]}},"URL":"https:\/\/doi.org\/10.2337\/diacare.27.2.461","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,2,1]]}}}