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

Abstract

Objective: We aimed to examine the effects of adding a longer-acting insulin glargine to existing glucose control on reducing blood-glucose fluctuations in an intensive care unit (ICU). Methods: A total of 110 patients randomly received adjuvant insulin glargine 15 IU/day (glargine) or placebo (control), in addition to daily infusion of insulin to maintain glucose levels at a target of 140-180 mg/dL. End points were mean and variance of blood glucose and frequency of hypoglycemia, hyperglycemia, ICU stay, and mortality. Data were analyzed with repeated-measures ANOVA and Mann-Whitney U test. Results: Average daily glucose level was significantly less in the glargine group than controls (P<0.0001), while there was no difference in daily variance in blood glucose between the two groups. The duration of glucose concentrations being within the target range was identical between the glargine and control groups (16.6±4.9 vs 16.4±4.6 hours/ day, P=0.844) during the 7 days of admission. The frequency of hypoglycemia was greater in the glargine group and total duration of hyperglycemia (>180 mg/dL) much longer among controls (P<0.001). Similar mortality rates were observed in both groups, while ICU length of stay was 2 days shorter in the glargine group. Conclusion: Addition of insulin glargine to routine protocols more effectively reduces glucose levels and decreases incidence of hyperglycemic episodes and regular insulin usage. This adjustment may be associated with decreases in duration of ICU stay or increases in hypoglycemic events.

Comparison between Continuous Regular Insulin Infusion and Single Dose Subcutaneous Long Acting Insulin Injection in Intensive Care Unit

“…In accordance with our results, Nader et al (21) evaluated 110 patients who, besides daily insulin infusions, were randomly assigned to receive adjuvant placebo (control) or insulin glargine 15 IU/day (glargine) to keep BG levels at a range of 140-180 mg/dl. They found that the average daily glucose level in the glargine group was significantly lower than in the control group, and they concluded that adding insulin glargine to regular protocols successfully lowers BG levels and minimizes the occurrence of hyperglycemia in addition to the need to regular insulin.…”

Incidence and Prediction of Unstable Blood Glucose Level among Critically Ill Patients: A Cohort Study

“…Intensive glucose control makes it possible to maintain ideal blood glucose levels and avoid extreme variations due to frequent monitoring of blood glucose with prompt intervention in the presence of blood glucose imbalances (Gunst, De Bruyn, & Van den Berghe, 2019). In addition to reducing the development of hyperglycemia, the use of intensive glucose control protocols also aids in decreased infections, hospital complications, all‐cause mortality, and acquired sepsis (Nader et al., 2020; Mahmoodpoor et al., 2016). The use of intensive glucose control protocol has also been associated with an increased risk of hypoglycemia.…”

Application of the PDCA Cycle for Managing Hyperglycemia in Critically Ill Patients

“…The American Diabetes Association (ADA) recommends a target glucose range of 140–180 mg/dL (7.8–10.0 mmol/L) for the majority of critically ill patients [ 1 ]. It is well documented that hyperglycemia, hypoglycemia, and glucose variability are independent risk factors for mortality of dysglycemic patients in the intensive care unit [ 2 ]. Stress hyperglycemia and diabetes are common conditions in the inpatient setting, with an estimated combined prevalence of 40% and an even higher prevalence in the critically ill.…”