Intravenous Insulin Infusion Protocol Compared With Subcutaneous Insulin for the Management of Hyperglycemia in Critically Ill Adults

Abstract

Background: The use of an intravenous insulin infusion protocol (IIP) is recommended for management of hyperglycemia in the intensive care unit (ICU); however, limited evidence of comparison has been made with subcutaneous (SC) insulin regimens. Objective: This study aims to evaluate the safety and effectiveness of an IIP compared with SC insulin regimens in an ICU patient sample since the implementation of an IIP using a computerized clinical-decision support tool. Methods: This investigation was a retrospective cohort study of patients who were treated for hyperglycemia while admitted to any of the ICUs at a Veterans Affairs Medical Center. Patients who were treated with either an IIP or a scheduled SC insulin regimen between May 1, 2015, and May 25, 2016, were included for evaluation. Results: Blood glucose (BG) was within the normoglycemia range (70-180 mg/dL) for 63.0% of the measurements in patients treated with an IIP (n = 171) compared with 45.7% in those treated with SC insulin regimens (n = 121; P < 0.01). Overall, patients managed with an IIP had a lower proportion of hypoglycemic BG measurements (1.2% vs 2.1%, P < 0.01), a lower proportion of hyperglycemic BG measurements (35.8% vs 52.2%, P < 0.01), and a lower mean BG (172.4 vs 194.3 mg/dL, P < 0.01). Conclusion and Relevance: The results of this study suggest that an IIP in a sample of adult ICU patients was associated with better BG control and lower occurrence of hypoglycemia compared with SC insulin regimens.

Intravenous Versus Subcutaneous Insulin in Management of Hyperglycaemia in Intensive Care Unit

“…Mean blood glucose levels in the IVII group were 157.11 ± 25.54 mg/dl, whereas, in the SCI group, it was 168.32 ± 30.49. In a similar study by Tran et al, 9 the mean blood glucose was 194, 3 in the subcutaneous Insulin group and 172, 4 in the intravenous Insulin group. The difference may be due to slightly different dosing regimens and more patients in Tran et al, 9 study.…”

“…In a similar study by Tran et al, 9 the mean blood glucose was 194, 3 in the subcutaneous Insulin group and 172, 4 in the intravenous Insulin group. The difference may be due to slightly different dosing regimens and more patients in Tran et al, 9 study. The ove-rall reasonable control of blood sugar with IVII may be associated with frequent monitoring of blood glucose levels and timely dose adjustments.…”

“…Subcutaneous regimens have been studied rarely, so little is known about their efficacy and safety in patients in critical care. Tran et al, 9 studied comparison of intravenous Insulin infusion (IVII) with subcutaneous Insulin (SCI) regimen and found that IVII was associated with better glucose control. However, effectively managing an IVII was more difficult than SCI.…”

Is subcutaneous insulin administration adequate for the management of hyperglycemic crisis in COVID-19?

“…Moreover, administration of SC rapid-acting insulin aspart presented better results than those of IV infusion of regular insulin in treating moderate DKA in pediatric patients with respect to faster/shorter hospital stay [13]. Nevertheless, in one retrospective cohort study [14], SC rapid-acting insulin analog was associated with higher hypoglycemic episodes and inefficient glucose control than IV insulin, although with comparable mortality rates. Although the use of SC rapid-acting insulin analog in managing this scenario remains controversial, it is in accordance with the Association of British Clinical Diabetologist (ABCD) guideline in managing DKA of COVID-19 [15]; a 4-h SC dose of rapid-acting insulin analog with an initial dose of 0.4 unit/kg with 2e4-h blood glucose monitoring seems to be a sensible alternative approach.…”

Effectiveness of blood glucose control protocol for open heart surgery patients

“…The most important changes in TP compared with the usual protocol in this research institute were as follows: First, the target level of BG was changed from 100–150 mg/dl to 100–180 mg/dl based on reported findings that a target level of BG ≤ 180 mg/dl decreased mortality rate, infection rate and length of stay in hospital and improved long‐term survival rate (Dellinger et al., 2013; Frioud et al., 2010; Jacobi et al., 2012). Second, the existing single‐dose injection of insulin was discontinued on the basis of the stability of the dynamic protocol to control BG only through continuous insulin injection (Tran et al., 2019) while maintaining the large framework of the non‐TP. Third, the interval between BG measurements was prolonged in consideration of the workload of ICU nurses in South Korea.…”