Impact of a Hyperglycemic Crises Protocol.
Endocr Pract. 2013 Jun 27;:1-23
Authors: Hara JS, Rahbar AJ, Jeffres MN, Izuora KE
Objective: The purpose of this study is to evaluate the efficacy and safety of an adult hyperglycemic crises protocol based upon the 2009 American Diabetes Association (ADA) consensus statement.Methods: Retrospective review of patients treated before and after protocol implementation at a university teaching hospital. 256 adult patients met criteria for diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) and were treated with an insulin infusion between February 2011 and February 2012 (non-protocol n = 143, protocol n = 113). Efficacy of the protocol was evaluated by assessing time to resolution of DKA or HHS, length of stay (LOS) in the intensive care unit (ICU), and LOS in the hospital. Safety of the protocol was evaluated by assessing the number of patients with hypoglycemic events, and the number of patients with hypokalemic events.Results: Patients on the hyperglycemic crises protocol experienced a 9.2 hour (95% confidence interval (CI): 4.70 - 13.70; P < 0.001) decrease in time to resolution with nonprotocol patients (n = 143) resolving in 22.78 hours and protocol patients (n = 113) resolving in 13.58 hours.,. There was no difference in the safety outcomes including the number of patients with moderate hypoglycemia (blood glucose < 70 mg/dL), severe hypoglycemia (blood glucose < 50 mg/dL), or hypokalemia (K+ < 3.3 mmol/L).Conclusion: Implementation of a hyperglycemic crises protocol decreased time to resolution of DKA and HHS without increasing the rate of hypoglycemia or hypokalemia.
PMID: 23807521 [PubMed - as supplied by publisher]