Association Between the Use of Long-Acting Insulin and Hypoglycemia in Critically Ill Patients with Diabetes
Recommended Citation
Ammar A, Sorochak N, Paxton R, Lipari M, and Giuliano C. Association Between the Use of Long-Acting Insulin and Hypoglycemia in Critically Ill Patients with Diabetes. J Intensive Care Med 2025.
Document Type
Article
Publication Date
9-1-2025
Publication Title
Journal of intensive care medicine
Abstract
Introduction: Hypoglycemia in critically ill patients increases morbidity and mortality. Subcutaneous long-acting insulin (LAI) in patients without diabetes is associated with hypoglycemia in the SICU. However, limited evidence exists in patients with diabetes.
Methods: This was a single-center, retrospective cohort study evaluating patients with T2DM who were admitted to the SICU for 24 h and received LAI in combination with sliding scale insulin (LAI + SSI) or sliding scale insulin (SSI) alone. The primary outcome was the incidence of hypoglycemia (BG < 70 mg/dL) in patients who received LAI + SSI or SSI. Secondary outcomes evaluated the number of glucose values across defined categories: hypoglycemia (54-70 mg/dL), severe hypoglycemia (< 54 mg/dL), euglycemia (70-180 mg/dL), hyperglycemia (>180 mg/dL) and glycemic variability.
Results: A total of 228 patients were included in the final analysis. The incidence of hypoglycemia occurred in 17.5% of patients in the LAI + SSI cohort and 18.4% in the SSI cohort (p = .86). After controlling for confounders, no differences were observed with LAI + SSI versus SSI for hypoglycemia (OR 1.09, 95% CI 0.46-2.6, p = .85). Secondary outcomes demonstrated no difference in total hypoglycemia (37 vs 31, p = .80), severe hypoglycemia (15 vs 34, p = .17) and euglycemia (1622 vs 1780, p = .22) in the LAI + SSI cohort compared to SSI alone. Hyperglycemia occurred more frequently with LAI + SSI. However, after adjusting for confounders there was no difference in hyperglycemia (OR 1.8, 95% CI 0.7-4.6, p = .22). No difference was observed in glycemic variability between LAI + SSI and SSI (26.5 vs 24.5, p = .21).
Conclusion and Relevance: The addition of LAI to SSI in SICU patients with T2DM was not associated with an increased risk of hypoglycemia.
Medical Subject Headings
hypoglycemia; long-acting insulin; sliding scale insulin; surgical intensive care unit; type 2 diabetes (T2DM)
PubMed ID
40888642
ePublication
ePub ahead of print
First Page
8850666251371709
Last Page
8850666251371709
