Glycemic Control Practices in Intensive Care Units: A National Survey Study

Abstract

Abstract

Objective: The objective of this study was to evaluate current glycemic management practices among intensive care unit (ICU) physicians in Türkiye, to identify inter-specialty and institutional variations, and to propose strategies for standardization in accordance with international guidelines.Methods: This cross-sectional, multicentre survey was conducted in 17 tertiary hospitals across Türkiye. The study population comprised specialists and residents from various medical disciplines, including intensive care unit (ICU), anesthesiology, internal medicine, pulmonology, and surgery. A 27-item guideline-based questionnaire was utilized to assess glucose thresholds, monitoring frequency, insulin therapy strategies, and the management of specific patient populations, including diabetic ketoacidosis and chronic organ failure. Construct validity (Kaiser–Meyer–Olkin = 0.72; Bartlett’s test, p < 0.001) and internal consistency (Cronbach’s α = 0.75) were confirmed. The data analysis was conducted using descriptive statistics, chi-square tests, and logistic regression; p < 0.05 was considered statistically significant.Results: A total of 83 physicians (67 specialists and 16 residents) participated. Reported hypoglycemia thresholds ranged from 60 to 90 mg/dL, while hyperglycemia thresholds ranged from 200 to 280 mg/dL. Seventy percent of respondents monitored blood glucose at least four times daily, and 56% preferred continuous insulin infusion for hyperglycemia management. Internal medicine specialists demonstrated higher adherence to frequent glucose monitoring (OR= 4.12, p=0.038) and insulin infusion use (OR=2.35, p=0.019) compared with anesthesiologists. HbA1c measurement was used by only 17% of participants, and continuous glucose monitoring was minimal. Hourly glucose monitoring in diabetic ketoacidosis was reported by 45% of respondents and was more frequent in university hospitals (OR = 2.30, p = 0.023).Conclusion: The management of glycemic levels in Turkish intensive care units (ICUs) exhibits significant heterogeneity, influenced by the specialty of the attending physician and the availability of institutional resources. The limited utilization of HbA1c testing and continuous glucose monitoring underscores the critical gaps in standardization. The implementation of unified national protocols, the expansion of multidisciplinary training programs, and increased support for continuous glucose monitoring may improve glycemic control and patient outcomes in ICUs across Türkiye.