BACKGROUND: 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. METHOD: 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. RESULTS: 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%). CONCLUSIONS: 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.
BACKGROUND: 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. METHOD: 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. RESULTS: 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%). CONCLUSIONS: 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.
Authors: Simon Finfer; Dean R Chittock; Steve Yu-Shuo Su; Deborah Blair; Denise Foster; Vinay Dhingra; Rinaldo Bellomo; Deborah Cook; Peter Dodek; William R Henderson; Paul C Hébert; Stephane Heritier; Daren K Heyland; Colin McArthur; Ellen McDonald; Imogen Mitchell; John A Myburgh; Robyn Norton; Julie Potter; Bruce G Robinson; Juan J Ronco Journal: N Engl J Med Date: 2009-03-24 Impact factor: 91.245
Authors: Judith Jacobi; Nicholas Bircher; James Krinsley; Michael Agus; Susan S Braithwaite; Clifford Deutschman; Amado X Freire; Douglas Geehan; Benjamin Kohl; Stanley A Nasraway; Mark Rigby; Karen Sands; Lynn Schallom; Beth Taylor; Guillermo Umpierrez; John Mazuski; Holger Schunemann Journal: Crit Care Med Date: 2012-12 Impact factor: 7.598
Authors: Jeroen Hermanides; Titia M Vriesendorp; Robert J Bosman; Durk F Zandstra; Joost B Hoekstra; J Hans Devries Journal: Crit Care Med Date: 2010-03 Impact factor: 7.598
Authors: Sean M Bagshaw; Rinaldo Bellomo; Michael J Jacka; Moritoki Egi; Graeme K Hart; Carol George Journal: Crit Care Date: 2009-06-17 Impact factor: 9.097