Document Type
Article
Abstract
Hyperglycemia, defined as a blood glucose level ≥180 mg/dL in the hospitalized patient, is linked to negative outcomes including longer hospital stays, increased infection risk, and higher morbidity and mortality rates. In addition to critically ill patients with diabetes, hyperglycemia can develop in individuals without diabetes due to factors such as steroid use, continuous tube feedings, and an elevated stress response. Patients who have uncontrolled hyperglycemia are often placed on continuous insulin infusions (CII), but rebound hyperglycemia frequently occurs after CII discontinuation if the maintenance insulin regimen (MIR) is insufficient. Implementation of a MIR decision support tool integrated within an insulin transition order set may lead to improved glucose control after discontinuation of a CII. This project’s primary aim was to reduce rates of rebound hyperglycemia after discontinuation of a CII by 25% over a 6-month period after implementation of the order set. This quality improvement study was conducted at a 760-bed tertiary care cancer hospital between March 1, 2023, to December 31, 2024. Patients 18 years or older who received a CII for at least 6 hours in the intensive care unit for hyperglycemia were included. Patients were excluded if they received a CII for hyperglycemic emergencies (eg, diabetic ketoacidosis), were under 18 years old, died within 24 hours of discontinuing CII, or transitioned to comfort care. The primary outcome was the rate of rebound hyperglycemia within 24 hours of CII discontinuation. Secondary outcomes included hypoglycemia rates, time to first hyperglycemic event, and the percentage of total daily dose (TDD) that was ordered as MIR over the past 24 hours. A total of 219 patients received a CII during the study period, of which 54 were excluded based on predetermined criteria. This resulted in a pre-order set (pre-MIR) group of 104 patients and a post-order set (post-MIR) group of 61 patients. Among the post-MIR group, only 15 patients had their MIR determined using the order set. Rebound hyperglycemia occurred in 79% of pre-MIR patients and 85% of post-MIR patients. There was no difference in rates of hypoglycemia, time to first hyperglycemia event, or percentage of TDD ordered as MIR between the pre-MIR and post-MIR groups. In conclusion, use of a MIR transition order set did not decrease the rate of rebound hyperglycemia, likely due to low utilization of and compliance to the order set.
Grants and Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Donovan DJ, Highsmith E, Khan S, Horng M. ICU Decision Tool Impact on Rebound Hyperglycemia. Advances in Cancer Education and Quality Improvement. 2026; 2(1).