目的:高血糖通常发生在从静脉内胰岛素输注(IVII)过渡到皮下胰岛素之后。基于体重的基础胰岛素在医疗重症监护病房(MICU)的IVII过程中较早开始,IVII后采用基于体重的基础推注方案,可以潜在地改善IVII后48小时的血糖控制。
方法:这项前瞻性研究纳入了69例MICU患者,这些患者的IVII治疗时间≥24小时。排除是终末期肾病,1型糖尿病,以及血管升压药的积极使用.干预组接受基于体重的基础胰岛素(0.2-0.25单位/kg)和IVII后基于体重的推注胰岛素。对照组接受当前护理。主要终点是IVII后48小时内特定时间间隔的葡萄糖水平。
结果:干预组25例,对照组44例。患者平均年龄为59±15岁,32(47%)是男性,52(78%)曾患有糖尿病。2组无差异(急性肾损伤/慢性肾脏病,预先存在的糖尿病,疾病严重程度,或IVII后无口腔状态),除了使用类固醇,对照组高于干预组(34%vs12%,分别)。直到IVII后36至48小时,葡萄糖水平才降低(166.8±39.1mg/dLvs220.0±82.9mg/dL,P<.001)。控制体重指数时,营养状况,血红蛋白A1C,和类固醇的使用,从12到24小时开始,葡萄糖水平较低(166.87mg/dLvs207.50mg/dL,P=.015)。两组之间的低血糖频率相似(5.0%vs7.1%)。该研究未达到目标入学率。
结论:在,和基础推注胰岛素后立即,MICU中的IVII在IVII后24小时导致更好的血糖控制,而低血糖没有增加。
OBJECTIVE: Hyperglycemia often occurs after the transition from intravenous insulin infusion (IVII) to subcutaneous insulin. Weight-based basal insulin initiated earlier in the course of IVII in the medical intensive care unit (MICU), and a weight-based basal-bolus regimen after IVII, can potentially improve post-IVII glycemic control by 48 hours.
METHODS: This prospective study included 69 patients in MICU who were on IVII for ≥24 hours. Exclusions were end-stage renal disease, type 1 diabetes mellitus, and the active use of vasopressors. The intervention group received weight-based basal insulin (0.2-0.25 units/kg) with IVII and weight-based bolus insulin after IVII. The control group received current care. The primary end points were glucose levels at specific time intervals up to 48 hours after IVII.
RESULTS: There were 25 patients in the intervention group and 44 in the control group. The mean age of the patients was 59 ± 15 years, 32 (47%) were men, and 52 (78%) had prior diabetes mellitus. The 2 groups were not different (acute kidney injury/chronic kidney disease, pre-existing diabetes mellitus, illness severity, or nothing by mouth status after IVII), except for the steroid use, which was higher in the control group than in the intervention group (34% vs 12%, respectively). Glucose levels were not lower until 36 to 48 hours after IVII (166.8 ± 39.1 mg/dL vs 220.0 ± 82.9 mg/dL, P < .001). When controlling for body mass index, nutritional status, hemoglobin A1C, and steroid use, glucose level was lower starting at 12 to 24 hours out (166.87 mg/dL vs 207.50 mg/dL, P = .015). The frequency of hypoglycemia was similar between the 2 groups (5.0% vs 7.1%). The study did not reach target enrollment.
CONCLUSIONS: The addition of weight-based basal insulin during, and basal-bolus insulin immediately after, IVII in MICU results in better glycemic control at 24 hours after IVII with no increased hypoglycemia.