Doolin Meagan K, Walroth Todd A, Harris Serena A, Whitten Jessica A, Fritschle-Hilliard Andrew C
Eskenazi Health, Department of Pharmacy, Indianapolis, IN, USA
Eskenazi Health, Department of Pharmacy, Indianapolis, IN, USA.
J Diabetes Sci Technol. 2016 Jun 28;10(4):932-8. doi: 10.1177/1932296816629985. Print 2016 Jul.
Glycemic control decreases morbidity and mortality in critically ill patients. However, limited guidance exists regarding the transition from intravenous (IV) to subcutaneous insulin therapy. A validated protocol for transition is necessary since glycemic variability, hyperglycemia, and hypoglycemia adversely impact patient outcomes.
The objective was to determine the safest and most effective method to transition critically ill adults from IV to subcutaneous insulin. This single-center, retrospective, observational study included adults admitted to the burn, medical, or surgical/trauma intensive care units from January 1, 2011, to September 30, 2014. A computer-based program provided a reflection of the patient's total daily IV insulin requirements. This information was then utilized to stratify patients into groups according to their initial dose of subcutaneous insulin as a percentage of the prior 24-hour IV requirements (group stratification: 0-49%, 50-59%, 60-69%, 70-79%, ≥80%). The primary endpoint was the percentage of blood glucose (BG) concentrations within target range (70-150 mg/dL) 48 hours following transition.
One hundred patients with 1394 BG concentrations were included. The 50-59% group achieved the highest rate of BG concentrations in goal range (68%) (P < .001). The 0-49% group, which was the transition method utilized most often, resulted in the lowest rate of goal achievement (46%).
This retrospective study suggests critically ill adults may be safely transitioned to 50-59% of their 24-hour IV insulin requirements. A dosing protocol will be implemented to transition to 50-70% subcutaneous insulin. Follow-up data will be reviewed to assess the protocol's safety and efficacy.
血糖控制可降低重症患者的发病率和死亡率。然而，关于从静脉胰岛素治疗过渡到皮下胰岛素治疗的指导有限。由于血糖变异性、高血糖和低血糖会对患者预后产生不利影响，因此需要一个经过验证的过渡方案。
目的是确定将重症成人患者从静脉胰岛素治疗过渡到皮下胰岛素治疗的最安全、最有效的方法。这项单中心、回顾性观察性研究纳入了2011年1月1日至2014年9月30日入住烧伤、内科或外科/创伤重症监护病房的成人患者。一个基于计算机的程序反映了患者每日静脉胰岛素的总需求量。然后利用这些信息，根据患者皮下胰岛素初始剂量占前24小时静脉胰岛素需求量的百分比，将患者分为不同组（分组：0-49%、50-59%、60-69%、70-79%、≥80%）。主要终点是过渡后48小时内血糖（BG）浓度在目标范围内（70-150mg/dL）的百分比。
共纳入100例患者，有1394次血糖浓度记录。50-59%组达到目标范围的血糖浓度率最高（68%）（P<0.001）。0-49%组是最常采用的过渡方法，目标达成率最低（46%）。
这项回顾性研究表明，重症成人患者可以安全地过渡到其24小时静脉胰岛素需求量的50-59%。将实施给药方案，过渡到50-70%的皮下胰岛素治疗。将审查随访数据，以评估该方案的安全性和有效性。
