Safety and efficacy of continuous insulin infusion in noncritical care settings

Background: Continuous insulin infusion (CII) to manage hyperglycemia is the accepted standard of care in the intensive care unit (ICU); however, the safety and efficacy of CII in the non-ICU setting has not been determined.

Research design and methods: This is a retrospective analysis of 200 consecutive patients receiving CII while admitted to general medical-surgical units at Emory University Hospital. We evaluated clinical outcomes and rates of hyperglycemia (blood glucose [BG] >200 mg/dL) and hypoglycemia (BG <60 mg/dL) events during CII.

Results: A total of 200 patients (age 52 +/- 16 years; male/female [M/F] 108/92) were admitted to general medicine (45%) or surgery (55%) services, 88.5% with history of diabetes and 41% treated with corticosteroids. The mean BG prior to and during the CII was 323 mg/dL and 170 mg/dL, respectively. Blood glucose of <or=150 mg/dL was the targeted goal in 85% of patients and 67% achieved a BG <or=150 mg/dL by hospital day 2. Hypoglycemia (BG <60 mg/dL) occurred at least once in 22% of patients, and severe hypoglycemia (BG <40 mg/dL) occurred in 5% of patients. Multivariate regression analyses showed that nutrition status during CII was associated with increased frequency of hyperglycemia and hypoglycemia. Compared to patients kept nil per os (NPO), oral intake during CII increased rates of hyperglycemic (P = 0.012) and hypoglycemic events (P = 0.035).

Conclusions: CII resulted in rapid and sustained glycemic control and a rate of hypoglycemic events similar to that reported in recent ICU trials. The rates of hypoglycemic and hyperglycemic events are significantly higher in patients allowed to eat during CII.