Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, CA.
Department of Pharmacy Services, University of Kentucky Healthcare, Lexington, KY.
Crit Care Med. 2019 May;47(5):700-705. doi: 10.1097/CCM.0000000000003709.
Insulin infusion therapy is commonly used in the hospital setting to manage diabetic ketoacidosis and hyperosmolar hyperglycemic state. Clinical evidence suggests both hypoglycemia and glycemic variability negatively impact patient outcomes. The hypothesis of this study was that moderate-intensity insulin therapy decreases hospital length of stay and prevalence of hypoglycemia in patients with diabetic ketoacidosis and hyperosmolar hyperglycemic state.
Pre-post study.
Large academic medical center in the United States.
Two-hundred one consecutive, nonpregnant, adult patients admitted for diabetic ketoacidosis and hyperosmolar hyperglycemic state between October 2010 and December 2014.
High-intensity insulin therapy versus moderate-intensity insulin therapy. High-intensity insulin therapy was designed to rapidly normalize blood glucose levels with bolus doses of insulin and rapid insulin titration. Moderate-intensity insulin therapy was designed to mitigate glycemic variability and hypoglycemia through avoidance of bolus dosing, a liberalized blood glucose target, and gradual insulin titration.
Hospital and ICU length of stay were reduced by 23.6% and 38%, respectively. The relative risk of remaining in the hospital at day 7 (0.51; p = 0.022) and day 14 (0.28; p = 0.044) were significantly reduced by the moderate-intensity insulin therapy strategy. The relative risk of remaining in the ICU at 48 hours was significantly lower in the moderate-intensity insulin therapy cohort (0.34; p = 0.0048). The prevalence (35% vs 1%; p = 0.0003) and relative risk (0.028; p = 0.0004) of hypoglycemia were significantly lower in the moderate-intensity insulin therapy cohort. Glycemic variability decreased by 28.6% (p < 0.0001). There was no difference in the time to anion gap closure (p = 0.123).
Moderate-intensity insulin therapy for diabetic ketoacidosis and hyperosmolar hyperglycemic state resulted in improvements in hospital and ICU length of stay, which appeared to be associated with decreased glycemic variability.
胰岛素输注疗法常用于医院环境中以治疗糖尿病酮症酸中毒和高渗高血糖状态。临床证据表明，低血糖和血糖变异性均对患者结局产生负面影响。本研究的假设是，中等强度的胰岛素治疗可降低糖尿病酮症酸中毒和高渗高血糖状态患者的住院时间和低血糖发生率。
前后研究。
美国一家大型学术医疗中心。
2010 年 10 月至 2014 年 12 月期间连续收治的 201 例非妊娠成年糖尿病酮症酸中毒和高渗高血糖状态患者。
高强度胰岛素治疗与中等强度胰岛素治疗。高强度胰岛素治疗旨在通过胰岛素推注和快速胰岛素滴定迅速使血糖水平正常化。中等强度胰岛素治疗旨在通过避免推注、放宽血糖目标和逐渐滴定胰岛素来减轻血糖变异性和低血糖。
住院和 ICU 住院时间分别缩短了 23.6%和 38%。中等强度胰岛素治疗策略显著降低第 7 天（0.51；p=0.022）和第 14 天（0.28；p=0.044）仍在住院的相对风险。中等强度胰岛素治疗组在 48 小时时 ICU 入住率的相对风险显著降低（0.34；p=0.0048）。中等强度胰岛素治疗组低血糖的发生率（35% vs 1%；p=0.0003）和相对风险（0.028；p=0.0004）显著降低。血糖变异性降低了 28.6%（p<0.0001）。阴离子间隙闭合时间无差异（p=0.123）。
糖尿病酮症酸中毒和高渗高血糖状态的中等强度胰岛素治疗可改善住院和 ICU 住院时间，这似乎与血糖变异性降低有关。
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