---
title: "Variability in Intravenous Insulin Infusion Management in Italian ICUs: National Nursing Survey"
id: "pubmed-42670715"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42670715"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42670715/"
doi: "10.1111/nicc.70656"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Variability in Intravenous Insulin Infusion Management in Italian ICUs: National Nursing Survey
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42670715
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42670715/)
- **DOI:** [10.1111/nicc.70656](https://doi.org/10.1111%2Fnicc.70656)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- A national cross-sectional survey of Italian intensive care unit nurses and nurse coordinators was conducted between September and November 2025 to describe reported practices in **continuous intravenous insulin infusion** management. - A structured questionnaire collected data on institutional characteristics, availability of insulin infusion protocols, **glycaemic targets**, insulin initiation thresholds, glucose measurement methods and monitoring frequency. - 128 valid responses were analysed; 119 respondents (93.0%) reported the presence of standardised insulin infusion protocols at their institutions. - Despite widespread reported protocol availability, the survey found substantial variability in reported practice across units, particularly in initiation thresholds, glucose measurement methods and monitoring frequency before glycaemic stabilisation. - The most commonly reported insulin initiation threshold was **180 mg/dL**, reported by 50.0% of respondents. - The median reported monitoring interval before glycaemic stabilisation was 120 minutes (interquartile range 60–240), which exceeds the recommended hourly checks during periods of glycaemic instability. - Exploratory comparisons suggested differences by healthcare setting in initiation thresholds, measurement methods and monitoring frequency, although staffing, workload and actual protocol adherence were not directly measured and thus cannot be confirmed as causes. - Authors conclude the findings support review of local insulin infusion protocols, clearer monitoring intervals during instability, staff education, audit and feedback, and escalation processes when glucose checks are delayed. - Keywords reported include **glucose monitoring**, **glycaemic control**, hyperglycaemia, insulin infusion, intensive care units and nursing practice.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. * 2 ASP Catanzaro, Catanzaro, Italy. * 3 Department of Clinical and Experimental Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy. * PMID: **42670715** * DOI: [ 10.1111/nicc.70656 ](https://doi.org/10.1111/nicc.70656) Item in Clipboard # Variability in Intravenous Insulin Infusion Management in Italian Intensive Care Units: A National Cross-Sectional Survey of Reported Nursing Practice Carmelo Pujia et al. Nurs Crit Care. 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID Nurs Crit Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Nurs+Crit+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Nurs+Crit+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670715/) . 2026 Sep;31(5):e70656. doi: 10.1111/nicc.70656. ### Authors [Carmelo Pujia](https://pubmed.ncbi.nlm.nih.gov/?term=Pujia+C&cauthor_id=42670715)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-1 "Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy."), [Giuseppe Neri](https://pubmed.ncbi.nlm.nih.gov/?term=Neri+G&cauthor_id=42670715)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-1 "Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy."), [Helenia Mastrangelo](https://pubmed.ncbi.nlm.nih.gov/?term=Mastrangelo+H&cauthor_id=42670715)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-2 "ASP Catanzaro, Catanzaro, Italy."), [Giuseppe Mazza](https://pubmed.ncbi.nlm.nih.gov/?term=Mazza+G&cauthor_id=42670715)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-1 "Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy."), [Eugenio Biamonte](https://pubmed.ncbi.nlm.nih.gov/?term=Biamonte+E&cauthor_id=42670715)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-1 "Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy."), [Caterina Mercuri](https://pubmed.ncbi.nlm.nih.gov/?term=Mercuri+C&cauthor_id=42670715)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-3 "Department of Clinical and Experimental Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy."), [Vincenzo Bosco](https://pubmed.ncbi.nlm.nih.gov/?term=Bosco+V&cauthor_id=42670715)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-1 "Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy."), [Tiziana Montalcini](https://pubmed.ncbi.nlm.nih.gov/?term=Montalcini+T&cauthor_id=42670715)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-3 "Department of Clinical and Experimental Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy."), [Eugenio Garofalo](https://pubmed.ncbi.nlm.nih.gov/?term=Garofalo+E&cauthor_id=42670715)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670715/#short-view-affiliation-1 "Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.") ### Affiliations * 1 Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. * 2 ASP Catanzaro, Catanzaro, Italy. * 3 Department of Clinical and Experimental Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy. * PMID: **42670715** * DOI: [ 10.1111/nicc.70656 ](https://doi.org/10.1111/nicc.70656) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Hyperglycaemia is common in critically ill patients and is associated with increased morbidity and mortality. Continuous intravenous insulin infusion is widely used for glycaemic control in intensive care units; however, its implementation is complex and requires frequent monitoring and substantial nursing involvement. **Aims:** To describe reported practices in continuous intravenous insulin infusion management across Italian intensive care units and to explore variability in glycaemic targets, insulin initiation thresholds, glucose measurement methods and monitoring frequency according to healthcare setting. **Study design:** A national cross-sectional survey. A structured questionnaire was distributed to intensive care unit nurses and nurse coordinators in Italy between September and November 2025. Data were collected on institutional characteristics, insulin infusion protocols, glycaemic targets, initiation thresholds, glucose measurement methods and monitoring practices. Exploratory comparisons by healthcare setting used cross-tabulations and exact tests, as appropriate. **Results:** A total of 128 valid responses were analysed. Standardised insulin infusion protocols were reported by 119 respondents (93.0%), but considerable variability was observed in reported practice. The most commonly reported insulin initiation threshold was 180 mg/dL (50.0%). Exploratory comparisons suggested differences across healthcare settings in initiation thresholds, glucose measurement methods and monitoring frequency before glycaemic stabilisation. The median reported monitoring interval before stabilisation was 120 min (interquartile range 60-240), exceeding the recommended hourly frequency during glycaemic instability. **Conclusions:** Despite widespread reported protocol availability, substantial variability remained in reported continuous intravenous insulin infusion management, particularly in initiation thresholds, glucose measurement methods and monitoring before glycaemic stabilisation. Because workload, staffing and protocol adherence were not directly measured, they should be considered possible explanations rather than study findings. **Relevance to clinical practice:** The findings support review of local insulin infusion protocols, explicit monitoring intervals during glycaemic instability, staff education, audit and feedback and escalation processes when glucose checks are delayed. **Keywords:** glucose monitoring; glycaemic control; hyperglycaemia; insulin infusion; intensive care units; nursing practice; practice variability. © 2026 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Impact of a Paper-Based Dynamic Insulin Infusion Protocol on Glycemic Variability, Time in Target, and Hypoglycemic Risk: A Stepped Wedge Trial in Medical Intensive Care Unit Patients. ](https://pubmed.ncbi.nlm.nih.gov/28118045/) Clergeau A, Parienti JJ, Reznik Y, Clergeau D, Seguin A, Valette X, du Cheyron D, Joubert M.Clergeau A, et al.Diabetes Technol Ther. 2017 Feb;19(2):115-123. doi: 10.1089/dia.2016.0314.Diabetes Technol Ther. 2017.PMID: 28118045 * [ Preferences for Blood Glucose Management in Adult Intensive Care Unit Patients-An International Survey. ](https://pubmed.ncbi.nlm.nih.gov/42223069/) Grigonyte-Daraskeviciene M, Granholm A, Møller MH, Kaas-Hansen BS, Meier N, Sivapalan P, Ellekjaer KL, Kamstrup AW, Wiis J, Haase N, Bestle MH, Gantzel CL, Bundgaard H, Michelsen J, Andreasen AS, Nissen TK, Crone V, Rasmussen BS, Hjortrup PB, Itenov T, Darfelt IS, Plovsing RR, Brøchner AC, Glargaard GL, Hicks MH, Long MT, Rogers WK, Banerjee A, Sreedharan R, Yockelson SR, Denchev K, Hoyler M, Maxey-Jones C, Cronhjort M, Alasjö M, Svensk E, Sjövall F, Lipcsey M, Oras J, Mårtensson J, Swedberg L, Jeitziner MM, Pietsch U, Holliger A, Pfortmueller CA, Gunst J, Boonen E, Hästbacka J, Valtonen M, Ala-Kokko T, Bäcklund M, Kiiski H, Bendel S, Öner Ö, Tokur ME, Hancı P, Elmas A, Gürkök MÇ, Nuri YM, Ergün B, Aydemir FD, Ergan B, Al-Fares AA, Young PJ, Jayasimhan D, Ostermann M, Arabi YM, Keus F, Perner A.Grigonyte-Daraskeviciene M, et al.Acta Anaesthesiol Scand. 2026 Jul;70(6):e70265. doi: 10.1111/aas.70265.Acta Anaesthesiol Scand. 2026.PMID: 42223069 * [ Feasibility and Performance of Continuous Glucose Monitoring to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit. ](https://pubmed.ncbi.nlm.nih.gov/38563491/) Ang L, Lin YK, Schroeder LF, Huang Y, DeGeorge CA, Arnold P, Akanbi F, Knotts S, DuBois E, Desbrough N, Qu Y, Freeman R, Esfandiari NH, Pop-Busui R, Gianchandani R.Ang L, et al.J Diabetes Sci Technol. 2024 May;18(3):562-569. doi: 10.1177/19322968241241005. Epub 2024 Apr 2.J Diabetes Sci Technol. 2024.PMID: 38563491Free PMC article. * [ Nursing Perspectives on Glycemic Control for Critically Ill Adults in the Intensive Care Unit: A Narrative Review. ](https://pubmed.ncbi.nlm.nih.gov/42207597/) Comisso I, Fonda F, Bressan S, Vuerich F, Maserin M, Narduzzi B, Bove T.Comisso I, et al.Dimens Crit Care Nurs. 2026 Jul-Aug 01;45(4):209-217. doi: 10.1097/DCC.0000000000000769. Epub 2026 May 28.Dimens Crit Care Nurs. 2026.PMID: 42207597Review. * [ The effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: A systematic review. ](https://pubmed.ncbi.nlm.nih.gov/26455610/) Higgs M, Fernandez R.Higgs M, et al.JBI Database System Rev Implement Rep. 2015 Jun 12;13(5):205-43. doi: 10.11124/jbisrir-2015-1911.JBI Database System Rev Implement Rep. 2015.PMID: 26455610 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42670715) ## References 1. 1. R. Sreedharan, A. Martini, G. Das, N. Aftab, S. Khanna, and K. Ruetzler, “Clinical Challenges of Glycemic Control in the Intensive Care Unit: A Narrative Review,” World Journal of Clinical Cases 10, no. 31 (2022): 11260–11272, . 2. 1. C. Kourek, M. Georgopoulou, K. Kolovou, et al., “Intensive Care Unit Hyperglycemia After Cardiac Surgery: Risk Factors and Clinical Outcomes,” Journal of Cardiothoracic and Vascular Anesthesia 38, no. 1 (2024): 162–169, . 3. 1. K. Yeşildal, F. Gültop, C. Kılınç Berktaş, M. Akkılıç, and N. Turgut, “The Impact of Insulin Requirement on Mortality and Morbidity in Non‐Diabetic COVID‐19 Patients in the Intensive Care Unit: A Retrospective Observational Study,” BMC Anesthesiology 25, no. 1 (2025): 160, [https://doi.org/10.1186/s12871‐025‐03037‐7](https://doi.org/10.1186/s12871%E2%80%90025%E2%80%9003037%E2%80%907). 4. 1. G. E. Umpierrez, R. Hellman, M. T. Korytkowski, et al., “Management of Hyperglycemia in Hospitalized Patients in Non‐Critical Care Setting: An Endocrine Society Clinical Practice Guideline,” Journal of Clinical Endocrinology and Metabolism 97, no. 1 (2012): 16–38, [https://doi.org/10.1210/jc.2011‐2098](https://doi.org/10.1210/jc.2011%E2%80%902098). 5. 1. S. Rovida, A. Bruni, C. Pelaia, et al., “Nurse‐Led Protocols for Control of Glycaemia in Critically Ill Patients: A Systematic Review,” Intensive & Critical Care Nursing 71 (2022): 103247, . Show all 16 references ## MeSH terms * Blood Glucose / analysis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Blood+Glucose%2Fanalysis%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Blood+Glucose) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670715/) * Continuous Glucose Monitoring Actions * [ Search in PubMed ](https://
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