Zhou K, et al. – Researchers performed a retrospective study of patients admitted to the Cleveland Clinic medical ICU (MICU) from June 2013 to January 2014 who received IV insulin infusion (IVII). It has been validated that the low rates of IV to subcutaneous (SC) insulin transitions raises the question of challenges to transitions.

Methods

• Researchers performed a retrospective study of patients admitted to the Cleveland Clinic MICU from June 2013 to January 2014 who received IVII.
• They correlated 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 24 hours).
• In this study, insulin doses applied for transitioning were compared with 80% of estimated 24h IVII total. Analysis was done using chi–square, ANOVA and t–tests.

Results

• In this study, 269 patients (NB 166, IB 45, CB 58) were included, 55% male with a mean age 58±16 years. 103 patients (38%) had a transition attempted (IB 21%, CB 17%).
• It was showed that 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).
• It was noted that IB and CB did not have significantly different BG with mean BG >180 mg/dL at 4/5 time intervals.
• Nevertheless, the dose of basal insulin applied was less than 80% of estimated 24h IVII total (IB 21.4 vs 49.6U, CB 25 vs 57.1U).
• Despite this, 15% of patients in the IB cohort and 24% of patients in the CB had hypoglycemic events.