[A comparison of efficacy and safety in the treatment of hyperglycemia with continuous subcutaneous insulin with insulin pump or multiple insulin injections daily in critical elderly patients].
OBJECTIVE
To compare efficacy and safety in the treatment of hyperglycemia with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injection (MDI) in critical elderly patients.


METHODS
Ninety-four elderly patients in critical condition with fasting glucose (10.3+/-2.5) mmol/L were randomly divided into CSII group (46 cases) and MDI group (48 cases). Soluble human insulin was used in both groups, and the treatment lasted for 7 days, and blood glucose level, average insulin dosage, percentage of hypoglycemia during 7 days, blood C-reacting protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) level and acute physiology and chronic health evaluation II (APACHE II) scores on the 7th day, and mortality during 28 days were observed.


RESULTS
Compared with MDI group, blood glucose was better controlled [76.1% (35/46) vs. 33.3% (16/48)], percentage of fair control of blood glucose level was higher [21.7% (10/46) vs. 14.6% (7/48)], percentage of poor control of blood glucose level was lower [2.2% (1/46) vs. 52.1% (25/48)], percentage of hypoglycemia was lower [10.9% (5/46) vs. 22.9% (11/48)], average insulin dosage during 7 days was less [(40.1+/-6.3) U/d vs. (46.2+/-7.1) U/d], serum TNF-alpha level [(11.5+/-2.7) microg/L vs. (19.8+/-4.2) microg/L], IL-6 level [(78.3+/-5.1)microg/L vs.(141.4+/-6.2) microg/L] and CRP level [(53.1+/-3.3) mg/L vs. (72.1+/-4.0) mg/L] on the 7th day was lower, APACHE II score was lower on the 7th day [(6.0+/-1.4) scores vs. (11.6+/-1.0) scores], and 28-day mortality was lower in CSII group [4.3% (2/46) vs. 16.7% (8/48)]. All the above values showed statistically significant difference between two groups (all P < 0.05).


CONCLUSIONS
CSII can better control blood glucose and alleviate inflammatory response and improve prognosis in elderly critically ill patients.
Huang
Wu
W
Department of Geriatrics, The Second Xiang Ya Hospital of Central South University, Changsha 410011, Hunan, China.
Liu
You-shuo
YS
Wang
Yan-jiao
YJ
Long
Li-min
LM
Li
Xia
X
Wang
Yi
Y
Yang
Yu
Y
D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin