Al Duhailib Zainab, Hakeam Hakeam, Almossalem Ammar, Alrashidi Ahood, Al Zhrani Abdulrahman, Al Salman Hassan, Alenizy Khalid, Alqafashat Sukaina, Alshalawi Munirah, Mohamed Gamal, Slessarev Marat, Rochwerg Bram
Critical Care Medicine Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
Endocr Pract. 2025 Apr;31(4):503-510. doi: 10.1016/j.eprac.2024.12.014. Epub 2024 Dec 25.
Dysglycemia has deleterious outcomes on critically ill patients with diabetes mellitus (DM). Insulin degludec, an ultralong-acting insulin, is associated with lower rates of hypoglycemia and blood glucose (BG) variability in non-critically ill patients. The experience with insulin degludec in the intensive care units is lacking. This study aimed to assess the effect of insulin degludec on glycemic control in critically ill patients with type 2 DM.
A prospective, interventional study enrolled critically ill patients with type 2 DM. Subjects were started on insulin degludec plus insulin regular correctional doses. BG levels were assessed every 6 hours. The primary outcome was the percentage of BG levels within a target of 140 to 180 mg/dL. The secondary outcomes included the median BG levels, severe hypoglycemia rate, and BG variability.
In total, 155 patients were enrolled. The percentage of BG levels within the target was 28.5%. The first day that the median of BG levels within target was on day 2 of insulin degludec therapy, which continued to be within the target for 1 week. Severe hypoglycemia developed in 5 patients (3.2%). The BG variability in the study was 26% using the coefficient of variation.
In critically ill patients with type 2 DM, one-fourth of BG levels were within the glycemic target (140-180 mg/dL) with insulin degludec plus insulin regular correctional doses. The median BG levels were in target starting the second day of insulin degludec therapy. The favorable BG variability using insulin degludec merits further investigation for effect on clinical outcomes.
血糖异常对重症糖尿病患者有不良影响。德谷胰岛素是一种超长效胰岛素，在非重症患者中，其与低血糖发生率降低及血糖（BG）变异性降低有关。目前缺乏在重症监护病房使用德谷胰岛素的经验。本研究旨在评估德谷胰岛素对重症2型糖尿病患者血糖控制的影响。
一项前瞻性干预性研究纳入了重症2型糖尿病患者。受试者开始使用德谷胰岛素加常规胰岛素校正剂量。每6小时评估一次BG水平。主要结局是BG水平在140至180mg/dL目标范围内的百分比。次要结局包括BG中位数水平、严重低血糖发生率和BG变异性。
共纳入155例患者。BG水平在目标范围内的百分比为28.5%。BG水平中位数达到目标的第一天是在德谷胰岛素治疗的第2天，此后持续1周保持在目标范围内。5例患者（3.2%）发生了严重低血糖。采用变异系数计算，本研究中的BG变异性为26%。
在重症2型糖尿病患者中，使用德谷胰岛素加常规胰岛素校正剂量时，四分之一的BG水平处于血糖目标范围内（140 - 180mg/dL）。德谷胰岛素治疗第2天起BG中位数水平达标。德谷胰岛素良好的BG变异性对临床结局的影响值得进一步研究。
