Comparison of Glycemic Control Between Continuous Regular Insulin Infusion and Single-Dose Subcutaneous Insulin Glargine Injection in Medical Critically Ill Patients

3] The incidence of this glycemic disorder is approximately 30%-60% which depends on the definition and diagnosis criteria in several critically ill settings. Alteration of gluconeogenesis and insulin receptor sensitivity are among the common pathophysiologies of stress-induced hyperglycemia. urthermore, certain ICU management strategies, including highly concentrated glucose intravenous fluid, catecholamine infusion, renal replacement therapy, and several medications, also carry the risk of developing hyperglycemia. ycemic control in the critically ill patient is generally recommended in standard ICU care. From a recent study and recommendation, a blood glucose level between 140 and180 mg/dL is strongly recommended in all patients who develop acute hyperglycemia with a blood glucose level >200 mg/dL during ICU admission. ] his specific type of insulin requires only a single daily dose Background and Aims: This study aimed to compare glycemic control between continuous intravenous regular insulin infusion and single-dose subcutaneous insulin glargine injection in medical critically ill patients. Subjects and Methods: A prospective noninferiority study was conducted in medical critically ill patients who developed hyperglycemia and required regular insulin infusion by the Intensive Care Unit glycemic control protocol. The eligible patients were switched from the daily regular insulin requirement to single-dose subcutaneous insulin glargine injection by a 100% conversion dose. Arterial blood glucose was checked every 2 h for 24 h. Success cases were blood glucose levels of 80-200 mg/dL during the study period. The mean time-averaged area under the curves (AUCs) of blood glucose levels between the two types of insulin were compared by t-test. Results: Of 20 cases, 14 cases (70%) were successful. The mean time-averaged AUCs of blood glucose levels between the two types of insulin were not significantly different (155.91 27.54 mg/dL vs. 151.70 17.07 mg/dL, P = 0.56) and less than the predefined noninferior margin. No severe hypoglycemic cases were detected during the study period. Conclusions: Single-dose subcutaneous insulin glargine injection was feasibly applied for glycemic control in medical critically ill patients. The glycemic control in the critically ill patients by a single dose of subcutaneous insulin glargine was comparable to standard intravenous regular insulin infusion. A conversion dose of 100% of the daily requirement of regular insulin is suggested.