Comparison of Glycemic Control Between Continuous Regular Insulin Infusion and Single-Dose Subcutaneous Insulin Glargine Injection in Medical Critically Ill Patients

Abstract

Background and Aims:This study aimed to compare glycemic control between continuous intravenous regular insulin infusion and single-dose subcutaneous insulin glargine injection in medical critically ill patients.Subjects and Methods:A prospective noninferiority study was conducted in medical critically ill patients who developed hyperglycemia and required regular insulin infusion by the Intensive Care Unit glycemic control protocol. The eligible patients were switched from the daily regular insulin requirement to single-dose subcutaneous insulin glargine injection by a 100% conversion dose. Arterial blood glucose was checked every 2 h for 24 h. Success cases were blood glucose levels of 80–200 mg/dL during the study period. The mean time-averaged area under the curves (AUCs) of blood glucose levels between the two types of insulin were compared by t-test.Results:Of 20 cases, 14 cases (70%) were successful. The mean time-averaged AUCs of blood glucose levels between the two types of insulin were not significantly different (155.91 ± 27.54 mg/dL vs. 151.70 ± 17.07 mg/dL, P = 0.56) and less than the predefined noninferior margin. No severe hypoglycemic cases were detected during the study period.Conclusions:Single-dose subcutaneous insulin glargine injection was feasibly applied for glycemic control in medical critically ill patients. The glycemic control in the critically ill patients by a single dose of subcutaneous insulin glargine was comparable to standard intravenous regular insulin infusion. A conversion dose of 100% of the daily requirement of regular insulin is suggested.

Costs of COVID-19 pandemic associated with diabetes in Europe: a health care cost model

“…Although data regarding the association of COVID-19 and diabetes control is limited, previous studies, investigating the association of diabetes control and other infections such as SARS and influenza have suggested that people with diabetes in poor glycaemic control have an increased risk of complications (43,44), in line with the findings of the association between COVID-19 and diabetes control.…”

<p>Effect of Adding Insulin Glargine on Glycemic Control in Critically Ill Patients Admitted to Intensive Care Units: A Prospective Randomized Controlled Study</p>

“…16 Bhurayanontachai et al showed the same results in stable patients in medical ICUs. 17 Datta et al showed that oncedaily insulin glargine provided better glycemic control than sliding-scale regular insulin after bariatric surgery. 13 Contrarily, Ergin et al showed that adding glargine insulin to regular rapid-acting insulin did not have a significant effect on dysglycemia management or its complications, 18 which may have been because of the lower incidence of hyperglycemia and lower severity scores of the patients included.…”

Assessment of risk, severity, mortality, glycemic control and antidiabetic agents in patients with diabetes and COVID-19: A narrative review

“…To minimize frequent exposure, use of SC short acting insulin analogues can be one approach, however, its role in critically ill patients is not fully known. Alternatively, to minimize the exposure, even a single per day SC dose of long-acting basal insulin could be an attractive option, as demonstrated in one study from Thailand that found a similar outcome when compared to continuous insulin infusion, in critically ill patients [76]. Models of Insulin pump or continuous subcutaneous insulin infusion (CSII), where insulin rates can be remotely adjusted via a Bluetooth can be useful to minimize exposure of HCP.…”