Data from the medical literature suggest a benefit of glycemic control during acute illness. Glycemic control can be accomplished easily by use of IV insulin infusions. However, IV insulin is often discontinued during a patient's recovery because of a host of factors, and postinfusion insulin therapy is often less effective at achieving glycemic control.
We tested a novel insulin infusion conversion equation (IICE) to calculate a patient's subcutaneous (SC) insulin requirements for 24 hours postinfusion. Patients with type I diabetes mellitus, pancreatitis, history of beta‐islet cell transplantation, or active pregnancy were excluded. All other patients at an academic urban teaching hospital on IV insulin were eligible. All enrolled patients were, at time of infusion cessation, started on scheduled doses of insulin glargine SC each evening and, if they were eating, insulin aspart SC before each meal. Enrolled patients were randomized to have their scheduled insulin doses determined either by IICE or by the patient's attending physician (non‐IICE). Insulin aspart by sliding scale (SS) was given for all blood sugars ≥ 150 mg/dL, with SS dosing calculated according to the doses of scheduled insulin. Hypoglycemia (blood glucose < 70 mg/dL) was treated. Blood sugars were checked every 4 hours for 24 hours post‐infusion to determine how many values were within a goal range of 80‐140 mg/dL. Patients were followed for the following clinical endpoints: length of stay after IV insulin cessation, incidence of infectious complications, and need for reinitiation of IV insulin therapy. The study was approved by the hospital institutional review board. The study is currently ongoing, and approximately 100 patients will be enrolled.
To date, 6 patients have been enrolled. The average blood glucose (± SD) in the IICE group was 140.33 ± 59.73 mg/dL; 66.6% of the blood glucose values were between 80 and 140 mg/dL. The average blood glucose in the non‐IICE group was 183.5 ± 54.85 mg/dL; 20% of the blood glucose values were between 80 and 140 mg /dL. No blood glucose values were less than 70 mg/dL. The odds of blood glucose control within the target range for the intervention group versus the control group was 10.32 (95% CI: 0.80134.4, P = .075). All enrolled patients are still hospitalized, so all other end points are undetermined.
In patients whose IV insulin infusion is converted to SC insulin dosing, use of our IICE equation creates a trend toward improved glycemic control. Further enrollment will be required to clarify this trend and determine effect on other patient outcomes.
G. Smith, Emory University School of Medicine, research funding; E. Omalley, none; J. Stein, none.
To cite this abstract:Smith G, O'Malley E, Stein J. Use of an Insulin Infusion Conversion Equation (MCE) to Improve Inpatient Glycemic Control. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 73. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/use-of-an-insulin-infusion-conversion-equation-mce-to-improve-inpatient-glycemic-control/. Accessed November 14, 2019.