ArticleFrontiers in endocrinology2026
Endocrinologist-led glucose management in the emergency ICU: a retrospective before-after study.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate the effectiveness and safety of an endocrinologist-led glucose management (ELGM) model integrating real-time continuous glucose monitoring (RT-CGM) and continuous insulin infusion therapy, compared with conventional glucose management in critically ill patients admitted to the emergency intensive care unit (EICU). Methods: In this single-center, retrospective before-after study, adult EICU patients with stays ≥24 hours were included. Patients admitted in 2023 received conventional glucose management (control), whereas those admitted in 2024 were managed using the ELGM model. Endocrinologists served as primary decision-makers, supported by RT-CGM, point-of-care testing, and continuous insulin infusion. Primary outcomes included mean glucose, glycemic variability, proportion of target-range glucose (3.9 - 10.0 mmol/L), and hypo-/hyperglycemia incidence. Secondary outcomes included nosocomial infection, hyperosmolar hyperglycemic state (HHS), length of stay, ventilation duration, and hospitalization costs. Results: A total of 1138 patients were analyzed (ELGM 625; Control 513). Compared with conventional management, the ELGM model was associated with lower mean glucose (9.9 vs. 11.1 mmol/L; P< 0.001) and reduced variability (SD 4.2 vs. 4.9 mmol/L; P< 0.001). Target-range readings were higher (61.11% vs. 51.66%; P< 0.001), and severe hyperglycemia was less frequent (7.45% vs. 13.28%; P< 0.001). Severe hypoglycemia did not differ. Nosocomial infection (15.02% vs. 27.68%) and HHS (1.28% vs. 5.65%) were lower (both P< 0.001). Length of stay and costs were similar, while ventilation duration was slightly longer. Conclusion: An endocrinologist-led glucose management strategy incorporating RT-CGM was associated with improved glycemic metrics and lower rates of severe hyperglycemia and infection, supporting its feasibility in critically ill patients.
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