Transitioning from intravenous to subcutaneous insulin in the medical intensive care unit.
Diabetes Res Clin Pract
; 134: 199-205, 2017 Dec.
Article
en En
| MEDLINE
| ID: mdl-29154154
ABSTRACT
BACKGROUND:
There is a paucity of studies on transitions from IV insulin infusion (IVII) to subcutaneous (SC) insulin in the medical ICU (MICU).METHODS:
We conducted a retrospective study of patients admitted to the Cleveland Clinic MICU from June 2013 to January 2014 who received IVII. We compared blood glucose (BG) control between 3 cohorts based on timing of basal insulin dose (1) NB (no basal), (2) IB (incorrect basal), (3) CB (correct basal) at 5 time points post-IVII discontinuation (1, 4, 8, 12, and 24h). Insulin doses used for transitioning were compared with 80% of estimated 24h IVII total. Analysis was done using chi-square, ANOVA and t-tests.RESULTS:
There were 269 patients (NB 166, IB 45, CB 58), 55% male with a mean age 58±16years. 103 patients (38%) had a transition attempted (IB 21%, CB 17%). The NB cohort had better BG than the IB cohort at all time points (p<0.001) but also lower HbA1c, prior DM diagnosis and home insulin use (p<0.001). IB and CB did not have significantly different BG with mean BG>180mg/dL at 4/5 time intervals. However, the dose of basal insulin used was less than 80% of estimated 24h IVII total (IB 21.4 vs 49.6U, CB 25vs 57.1U). Despite this, 15% of patients in the IB cohort and 24% of patients in the CB had hypoglycemic events.CONCLUSION:
The low rates of IV to SC insulin transitions raises the question of challenges to transitions.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Glucemia
/
Infusiones Intravenosas
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Sistemas de Infusión de Insulina
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Hipoglucemiantes
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Inyecciones Subcutáneas
/
Insulina
Tipo de estudio:
Observational_studies
Límite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Diabetes Res Clin Pract
Asunto de la revista:
ENDOCRINOLOGIA
Año:
2017
Tipo del documento:
Article