title: Evaluation of glucose variability when converting from insulin infusion to basal-bolus regimen in a surgical-trauma intensive care unit.
abstract: OBJECTIVE
  This study aimed to identify predictive factors resulting in glucose values greater than 200 mg/dL in patients with trauma transitioned from an insulin infusion to a basal-bolus subcutaneous insulin regimen.
  
  
  METHODS
  Thirty-nine patients with trauma on goal enteral nutrition in the intensive care unit receiving an insulin infusion for at least 48 hours and transitioned to a basal-bolus regimen were retrospectively identified.
  
  
  RESULTS
  Ten patients had hyperglycemic events after transition. Hyperglycemia was significantly associated with increased age (42 [17] years vs 56 [13] years, P=.02), admission glucose (128 [39] mg/dL vs 214 [91] mg/dL, P=.015), and insulin drip rate 48 hours before transition (87 [38] units/d vs 127 [49] units/d, P=.012). There was no difference between groups with respect to injury severity, demographics, or physiologic parameters. Multiple regression analysis revealed that increased age (odds ratio [OR], 1.215 [1.000-1.477]; P=.05), increased admission blood glucose (OR, 1.053 [1.006-1.101]; P=.025), and higher insulin infusion rates 48 hours before transition (OR, 1.061 [1.009-1.116]; P=.020) predisposed patients to severe hyperglycemic episodes.
  
  
  CONCLUSIONS
  Older patients with trauma and patients with higher blood glucose on admission are more likely to experience severe hyperglycemia when transitioned to basal-bolus glucose control. Higher insulin infusion rates at 48 hours before transition are also associated with severe hyperglycemia.
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, PO Box 250584, Charleston, SC 29425. Electronic address: mckinzi@musc.edu.
authors.forename: Brian P
authors.initials: BP
authors.lastname: McKinzie
authors.forename: Long
authors.initials: L
authors.lastname: To
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Leon
authors.forename: Evert A
authors.initials: EA
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Basal-bolus regimen; Glucose; Glucose variability; Insulin; Trauma