(283) Impact of an ICU Pharmacist Insulin Co-Management Protocol on Glycemic Metrics in the ICU

Introduction: There is a strong correlation between poor glucose control and increased morbidity and mortality in patients admitted to the intensive care unit (ICU). Studies evaluating non-physician directed insulin management have largely been conducted in non-ICU patients and have lacked outcomes specific to individualized glycemic control. This study evaluates the impact of an ICU pharmacist driven protocol on glycemic metrics at a large academic medical center (AMC).

Methods: This was a retrospective pre-post study conducted in 7 adult ICUs at an AMC. Patients in the pre-group were all ICU admitted patients from April 2023 through September 2023 regardless of having an insulin order. Patients in the post-intervention group were patients admitted to the ICU from February 26, 2024 to July 24, 2024 with orders for subcutaneous or intravenous insulin. Patients were excluded from the pharmacist driven protocol if there was an endocrinology or inpatient glycemic consult, or if providers opted-out of the protocol via an EMR order. The primary outcome was the percentage of patients with a day weighted mean BG ≥ 180 mg/dL. Secondary outcomes include percentage of patient days with a hypoglycemic event ( < 70 mg/dL, < 54 mg/dL, and < 40 mg/dL).

Results: The post-intervention group interim analysis included 349 glycemic interventions by ICU pharmacists impacting 162 patients. In the pre-intervention group, 21% of ICU patients had a day weighted mean BG ≥ 180 mg/dL compared to 14% in the post-intervention group. The percent of patient days with a mild ( < 70 mg/dL) hypoglycemic episode between the pre- and post-intervention group was 3.6% vs 3.4%, moderate ( < 54 mg/dL) was 1% vs 1.2%, and severe ( < 40 mg/dL) was 0.3 % vs 0.1%, respectively.

Conclusions: Findings suggest that co-management of insulin by ICU pharmacists has demonstrated improved glycemic outcomes in the ICU without notable increases in hypoglycemic events. Future analyses in post-ICU populations will further assess the impact of ICU pharmacist interventions on ward glycemic control and LOS.