title: Effectiveness of regular versus glargine insulin in stable critical care patients receiving parenteral nutrition: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the effectiveness and safety of two glycemic control regimens in stable critical care patients receiving parenteral nutrition (PN).
  
  
  METHODS
  Prospective, randomized open-label clinical trial.
  
  
  METHODS
  Eligible postoperative critical care patients in the ICU began PN on the first to the seventh day of ICU admission. The PN admixture included regular insulin, in doses sufficient to maintain 3 or more goal blood glucose (BG) levels between 110 and 180 mg/dl. After 3 to 5 days of PN containing regular insulin, patients were randomized to 3 more days of regular insulin at the same dose or 80% of their total daily regular insulin dose provided in PN solution as glargine insulin. Capillary BG monitoring was performed every 6 hours.
  
  
  RESULTS
  Twenty one patients were randomized to each treatment group. Median APACHE II scores were not significantly different between the two groups within the first 24-hour of ICU admission. There were no significant differences between the two groups at day 3 for mean daily dextrose (306.9 ± 46.2 vs. 305.2 ± 52.2 g; p=0.913) or insulin (18.3 ± 8.8 vs. 19.5 ± 10.0 units; p=0.696) doses. The percentage of BG values in the goal (110-180 mg/dl), hyperglycemic (> 180 mg/dl), and hypoglycemic (< 70 mg/dl) BG levels were similar between the two groups (69.0% vs. 66.7%, p=0.567; 11.9% vs. 11.1%, p=0.780; 0% vs. 1.6%, p=0.124, respectively). Mean daily BG levels were not significantly different between the two groups on each of the 3 study days (day 1: 140 ± 20 vs. 131 ± 25 mg/dl, p=0.194; day 2: 136 ± 20 vs. 140 ± 18 mg/dl, p=0.498; day 3: 142 ± 15 vs. 140 ± 19 mg/dl; p=0.741).
  
  
  CONCLUSIONS
  These data suggest that, compared with regular insulin added to PN, glargine insulin results in similar glycemic control and rates of hyperglycemia and hypoglycemia in stable critical care patients.
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Bagher
authors.initials: MB
authors.lastname: Oghazian
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Javadi
authors.forename: Mania
authors.initials: M
authors.lastname: Radfar
authors.forename: Hassan
authors.initials: H
authors.lastname: Torkamandi
authors.forename: Mostafa
authors.initials: M
authors.lastname: Sadeghi
authors.forename: Alireza
authors.initials: A
authors.lastname: Hayatshahi
authors.forename: Kheirollah
authors.initials: K
authors.lastname: Gholami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects; D003422:Critical Care; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000494:pharmacology*; D007328:Insulin / Q000494:pharmacology*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000494:pharmacology*; D007362:Intensive Care Units; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine
keywords: glargine insulin; glycemic control; parenteral nutrition; regular insulin