Association Between the Use of Long-Acting Insulin and Hypoglycemia in Nondiabetic Patients in the Surgical Intensive Care Unit.
OBJECTIVE
The purpose of this study was to examine the association between long-acting insulin and hypoglycemia in nondiabetic surgical intensive care patients.


METHODS
This single-center, retrospective cohort study evaluated glycemic control in nondiabetic critically ill surgical patients receiving long-acting insulin plus sliding scale versus those receiving sliding scale alone. Patients were matched based on sliding scale order and type of surgery. The primary outcome was the proportion of patients who experienced hypoglycemia (glucose values <70 mg/dL). Secondary outcomes included comparing the distribution of glycemic events in the 2 groups and describing the proportion of patients transferred out of the intensive care unit on long-acting insulin who experienced hypoglycemia.


RESULTS
One hundred twenty patients met the study criteria. Hypoglycemia was significantly higher in the long-acting insulin plus sliding scale group compared to those receiving sliding scale alone (17 [28.3%] patients vs 8 [13.3%] patients; P = .047). After adjusting for body mass index, renal failure, age, and Acute Physiology and Chronic Health Evaluation II, the odds of hypoglycemia were 4.1 times higher for patients receiving long-acting insulin and sliding scale compared to those receiving sliding scale alone ( P = .02). There were more hypoglycemic events (42 vs 20; P = .05) and hyperglycemic events (313 vs 135; P = .02) in the long-acting insulin group.


CONCLUSIONS
This study demonstrated higher rates of hypoglycemia associated with the utilization of long-acting insulin in nondiabetic surgical intensive care patients. Risk of hypoglycemia should be weighed against possible benefits in this population.
1 Department of Pharmacy, St. John Hospital and Medical Center, Detroit, MI, USA.
Jordan
J
Masse
1 Department of Pharmacy, St. John Hospital and Medical Center, Detroit, MI, USA.|2 Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA.
Christopher Alan
CA
Giuliano
1 Department of Pharmacy, St. John Hospital and Medical Center, Detroit, MI, USA.
Sara
S
Brown
3 Surgical Intensive Care Unit, St. John Hospital and Medical Center, Detroit, MI, USA.
Renee Alexander
RA
Paxton
D018806:APACHE; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D049528:Insulin, Long-Acting / Q000009:adverse effects*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting
basal insulin; critical care; hypoglycemia; insulin detemir; insulin glargine; long-acting insulin