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Protocol-directed insulin infusion sliding scales improve perioperative hyperglycaemia in critical care

Hui, Man Lin; Kumar, Arun; Adama, Gary G.


Man Lin Hui

Arun Kumar

Gary G. Adama


Perioperative hyperglycaemia is associated with poor outcomes in patients undergoing cardiac surgery. Frequent postoperative hyperglycaemia in cardiac surgery patients has led to the initiation of an insulin infusion sliding scale for quality improvement.

A systematic review was conducted to determine whether a protocol-directed insulin infusion sliding scale is as safe and effective as a conventional practitioner-directed insulin infusion sliding scale, within target blood glucose ranges.

A literature survey was conducted to identify reports on the effectiveness and safety of an insulin infusion protocol, using seven electronic databases from 2000 to 2012: MEDLINE, CINAHL, EMBASE, the Cochrane Library, the Joanna Briggs Institute Library and SIGLE. Data were extracted using pre-determined systematic review and meta-analysis criteria.

Seven research studies met the inclusion criteria. There was an improvement in overall glycaemic control in five of these studies. The implementation of protocols led to the achievement of blood glucose concentration targets more rapidly and the maintenance of a specified target blood glucose range for a longer time, without any increased frequency of hyperglycaemia. Of the seven studies, four used controls and three had no controls.

In terms of the meta-analysis carried out, four studies revealed a failure of patients reaching target blood glucose levels (P < 0.0005) in the control group compared with patients in the protocol group. The risk of hypoglycaemia was significantly reduced (P

Journal Article Type Article
Publication Date Oct 6, 2012
Journal Perioperative Medicine
Electronic ISSN 2047-0525
Publisher Humana Press
Peer Reviewed Peer Reviewed
Volume 1
Issue 7
Institution Citation Hui, M. L., Kumar, A., & Adama, G. G. (2012). Protocol-directed insulin infusion sliding scales improve perioperative hyperglycaemia in critical care. Perioperative Medicine, 1(7), doi:10.1186/2047-0525-1-7
Publisher URL
Copyright Statement Copyright information regarding this work can be found at the following address:


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