Pharmaceutical Care Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Pharmaceutical Care Department, King Fahad Armed Forces hospital, Jeddah, Saudi Arabia.
Sci Rep. 2024 May 2;14(1):10128. doi: 10.1038/s41598-024-57403-5.
Glycemic variability (GV) has been associated with an increased mortality rate among critically ill patients. The clinical outcomes of having less GV even with slight hyperglycemia are better than those having tight glycemic control but higher GV. Insulin infusion remains the preferred method to control stress hyperglycemia in critically ill patients. However, its impacts on GV and clinical outcomes in critically ill patients still need further investigation. This study intended to evaluate the impact of insulin infusion therapy (IIT) compared to the insulin sliding scale (ISS) on the extent of GV and explore its impact on the clinical outcomes for critically ill patients. A prospective, single-center observational cohort study was conducted at a tertiary academic hospital in Saudi Arabia between March 2021 and November 2021. The study included adult patients admitted to ICUs who received insulin for stress hyperglycemia management. Patients were categorized into two groups based on the regimen of insulin therapy during ICU stay (IIT versus ISS). The primary outcome was the GV between the two groups. Secondary outcomes were ICU mortality, the incidence of hypoglycemia, and ICU length of stay (LOS). A total of 381 patients were screened; out of them, eighty patients met the eligibility criteria. The distribution of patients having diabetes and a history of insulin use was similar between the two groups. The GV was lower in the IIT group compared to the ISS group using CONGA (- 0.65, 95% CI [- 1.16, - 0.14], p-value = 0.01). Compared with ISS, patients who received IIT had a lower incidence of hypoglycemia that required correction (6.8% vs 2.77%; p-value = 0.38). In contrast, there were no significant differences in ICU LOS and ICU mortality between the two groups. Our study demonstrated that the IIT is associated with decreased GV significantly in critically ill patients without increasing the incidence of severe hypoglycemia. There is no survival benefit with the use of the IIT. Further studies with larger sample size are required to confirm our findings and elaborate on IIT's potential effect in reducing ICU complications in critically ill patients.
血糖变异性（GV）与危重症患者死亡率增加有关。与严格血糖控制但 GV 较高相比，即使存在轻度高血糖，GV 较低的临床结局也更好。胰岛素输注仍然是控制危重症患者应激性高血糖的首选方法。然而，其对危重症患者 GV 和临床结局的影响仍需要进一步研究。本研究旨在评估与胰岛素推注疗法（IIT）相比，胰岛素滴注疗法（ISS）对 GV 程度的影响，并探讨其对危重症患者临床结局的影响。这是一项在沙特阿拉伯一家三级学术医院进行的前瞻性、单中心观察性队列研究，研究时间为 2021 年 3 月至 2021 年 11 月。该研究纳入了接受胰岛素治疗应激性高血糖的 ICU 住院患者。根据 ICU 期间胰岛素治疗方案（IIT 与 ISS）将患者分为两组。主要结局是两组之间的 GV。次要结局是 ICU 死亡率、低血糖发生率和 ICU 住院时间（LOS）。共筛选了 381 名患者，其中 80 名符合入选标准。两组患者中患有糖尿病和使用胰岛素史的患者分布相似。与 ISS 组相比，IIT 组的 CONGA 较低（-0.65，95%CI[-1.16，-0.14]，p 值=0.01）。与 ISS 相比，接受 IIT 的患者需要纠正的低血糖发生率较低（6.8%比 2.77%；p 值=0.38）。然而，两组间 ICU LOS 和 ICU 死亡率无显著差异。本研究表明，IIT 可显著降低危重症患者的 GV，而不会增加严重低血糖的发生率。使用 IIT 并没有生存获益。需要进一步的研究来证实我们的发现，并详细阐述 IIT 在降低危重症患者 ICU 并发症方面的潜在作用。
