Assessing outcomes of intravenous insulin therapy in non-intensive care patients

ABSTRACT

Objectives

The aim of this study was to compare outcomes of using intravenous insulin infusion (IVII) therapy for managing hyperglycemia in a non-intensive care unit (ICU) versus an ICU setting.

Methods

We conducted a retrospective analysis on patients who received IVII for hyperglycemia. The analysis compared variables associated with hypoglycemic events while on IVII, and point-of-care blood glucose control and insulin regimens at discharge. Insulin administration errors occurring on IVII were determined.

Results

Between November 2020 and August 2022, 881 patients received 1,106 IVIIs (780 in ICU and 326 non-ICU). A cumulative 468 days were spent on IVII in the non-ICU setting and 1564 in the ICU (total 2,032 days). The frequency of hypoglycemia on IVII was higher when provided in the non-ICU vs ICU (1.4% vs 0.7%), p < 0.01). Non-ICU patients had significantly higher average blood glucose during the last 24 h of the hospital stay (185 mg/dL vs 160 mg/dL, non-ICU vs. ICU, Pp < 0.01) and were more likely discharged with basal-bolus insulin therapy (p < 0.01). After adjusting for other variables, the probability of having hypoglycemia (OR 2.35; 95% CI 1.62–3.42; p < 0.001) was higher for the non-ICU cohort. In addition, patients who received IVII in the non-ICU settings had mean glucose levels nearly 26 mg/dL higher (95% CI 19.40–32.9, p < 0.001) at discharge vs. ICU. Seven cases of insulin errors were reported while on IVII in the non-ICU settings, compared to one in the ICU.

Conclusions

A large number (468) of ICU days were avoided by providing IVII in the non-ICU setting. Of the more than 400 days of IVII therapy provided in the non-ICU, only 7 medication errors occurred. Further studies are needed to optimize IVII strategy for non-ICU patients.

KEYWORDS:

• Diabetes
• insulin drip
• glucose control
• intravenous insulin infusion therapy
• intensive care unit
• hypoglycemia risk

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

Each author contributed individually to the authorship of the paper. Bithika M. Thompson and Curtiss B. Cook were responsible for conceptualization, methodology, supervision, and manuscript writing and editing. Mercedes Martinez-Gil participated in the investigation and manuscript writing. Rodrigo Fonseca curated and formally analyzed the data. Janna C. Castro and Leila K. Tehrani contributed to data abstraction and curation. Shon E. Meek was involved in the development of the insulin infusion algorithm. All authors have reviewed and approved the final draft of the manuscript.

Additional information

Funding

This paper was not funded.