Pharmacy Services, Orlando Regional Medical Center, Orlando, Florida.
Pharmacotherapy. 2020 Mar;40(3):186-190. doi: 10.1002/phar.2373. Epub 2020 Feb 25.
Twice/day dosing of insulin glargine has been used to treat hyperglycemia in clinical practice; however, data supporting its use in the critically ill population are lacking. This study was designed to evaluate the safety and efficacy of twice/day insulin glargine in critically ill patients.
A retrospective study was conducted in adult patients admitted to the intensive care units between February 2013 and June 2017 who received insulin glargine twice/day or 40 units or more once/day for 48 hours or longer. Post cardiovascular surgery patients were excluded. Data were collected for up to 14 patient-days. The efficacy outcomes included the incidence of hyperglycemia (blood glucose [BG] above 180 mg/dl), predose hyperglycemia rate (BG above 180 mg/dl within 4 hrs before the dose), and BG variability (standard deviation). The safety outcome was assessed by the development of hypoglycemia (BG below 70 mg/dl).
A total of 58 patients (twice/day = 23; once/day = 35) were included in the analysis. Demographics were similar between the groups including history of diabetes mellitus, baseline hemoglobin A , and home insulin use. No difference was observed between the twice/day and once/day groups in the mean BG (153 vs 154 mg/dl, p=0.95, respectively), and BG variability (46 vs 44 mg/dl, p=0.29, respectively). Although the overall incidence of hyperglycemia was similar between twice/day and once/day groups (96% vs 97%, p=1.00, respectively), the twice/day group had a significantly lower predose hyperglycemia rate (twice/day 0.27 vs once/day 0.43, p=0.02). Additionally, the twice/day group did not experience an increased incidence of hypoglycemia (twice/day 23% vs once/day 34%, p=0.57) or hypoglycemia without having anything by mouth (twice/day 0% vs once/day 9%, p=0.27).
This is the first study demonstrating that twice/day insulin glargine reduced the rate of predose hyperglycemia without increasing the risk of hypoglycemia in critically ill patients. A large randomized study is needed to confirm the safety and efficacy of twice/day glargine in the critically ill.
临床上常采用甘精胰岛素每日两次给药来治疗高血糖；然而，目前缺乏该药在危重症人群中应用的数据。本研究旨在评估每日两次给予甘精胰岛素在危重症患者中的安全性和疗效。
这是一项回顾性研究，纳入 2013 年 2 月至 2017 年 6 月期间入住重症监护病房且接受每日两次或每日 40 单位或以上甘精胰岛素治疗 48 小时或更长时间的成年患者。排除心脏手术后患者。数据采集时间最长达 14 天。疗效指标包括高血糖（血糖[BG]＞180mg/dl）发生率、餐前高血糖率（给药前 4 小时内 BG＞180mg/dl）和 BG 变异性（标准差）。安全性结局为低血糖（BG＜70mg/dl）的发生情况。
共纳入 58 例患者（每日两次 23 例；每日一次 35 例）进行分析。两组患者的一般资料相似，包括糖尿病病史、基线糖化血红蛋白和家庭用胰岛素。两组患者的平均 BG（分别为 153mg/dl 和 154mg/dl，p=0.95）和 BG 变异性（分别为 46mg/dl 和 44mg/dl，p=0.29）无差异。虽然每日两次和每日一次组的高血糖总发生率相似（96% vs 97%，p=1.00），但每日两次组的餐前高血糖率显著较低（每日两次 0.27% vs 每日一次 0.43%，p=0.02）。此外，每日两次组并未增加低血糖发生率（每日两次 23% vs 每日一次 34%，p=0.57）或未进食时发生的低血糖（每日两次 0% vs 每日一次 9%，p=0.27）。
本研究首次表明，每日两次甘精胰岛素可降低餐前高血糖发生率，同时不增加危重症患者低血糖风险。需要开展大型随机研究来证实每日两次甘精胰岛素在危重症患者中的安全性和疗效。
