(987) Evaluation of Long-Acting Insulin in the Critically Ill for Stress-Induced Hyperglycemia

Introduction: Although commonly used, there have been limited studies evaluating the use of intermediate and long acting insulin in critically ill populations for stress-induced hyperglycemia. Newer evidence has evaluated blood glucose goals based on patients’ premorbid diabetes status and glycemic control prior to hospital admission. The purpose of this study was to compare the difference in hypoglycemic events with the use of intermediate and long acting insulin analogues in critically ill patients based on premorbid diabetes status.

Methods: This was a retrospective cohort study in nonsurgical, critically ill adults admitted to the medical or neuroscience critical care services and received at least 96 hours of basal insulin between 2014 and 2021. The primary endpoint was the difference in hypoglycemic events between diabetic and non-diabetic patients with the use of intermediate acting versus long acting insulin. Secondary endpoints included difference in hypoglycemia based on baseline hemoglobin A1c (HbA1c), difference in hypoglycemia within diabetic and non-diabetic patients, and blood glucose time in range difference.

Results: A total of 250 patients were included and analyzed. Baseline characteristics and nutrition at insulin initiation were similar between the groups. Overall, 80 (32%) had at least one hypoglycemic event requiring dextrose 50% (D50) administration. Diabetic patients receiving basal insulin overall were more likely to experience at least one hypoglycemic event compared to non-diabetic patients (35.7% vs. 14.0%, p=.006). With intermediate acting insulin, diabetic patients were also more likely to experience at least one hypoglycemic event compared to non-diabetic patients (38.1% vs. 13.8%, p=.016). There was no significant difference in hypoglycemic events between the HbA1c groups with intermediate acting, long acting, or basal insulin overall. Non-diabetic patients had a higher percent time in range (39.9% vs. 33.7%, p=.016).

Conclusions: Critically ill diabetic patients receiving basal insulin were significantly more likely to experience hypoglycemia, with intermediate acting insulin use more frequently associated with hypoglycemic events. These findings suggest that long acting insulin may be safer to use in critically ill diabetic patients compared to intermediate acting insulin.