(392) Glycemic Control in Critically Ill Adult Patients With Regular Insulin Added to Parenteral Nutrition

Introduction: Parenteral nutrition (PN) is common in critically ill patients. This can cause hyperglycemia and glucose variability, leading to an increased risk of infection and mortality. While regular insulin in parenteral nutrition (RI-in-PN) is an established modality for glucose control in non-critically ill patients, more data is needed on its use in critically ill patients. The primary objective of this study is to determine the utility of using regular insulin in parental nutrition as a modality to achieve blood glucose control in critically ill patients.

Methods: This is a single-center retrospective chart review of critically ill adult patients receiving PN in surgical intensive care unit (ICU) settings. Sixty patients were randomly selected to form 3 groups (N=20 in each group). One group used RI-in-PN (Cardiovascular ICU (CVICU) patients), and two did not (a CVICU and Surgical ICU(SICU) group). The primary outcome is rates of hypoglycemia ( < 70 mg/dL and < 54 mg/dL) and hyperglycemia (>180 mg/dL and >250 mg/dL). Secondary outcomes include time in the blood glucose range of 70-180 mg/dL, coefficient of variation as a marker of glucose variability, use of other insulin modalities, ICU length of stay, infection, and mortality rates.

Results: Preliminary data shows 4 hypoglycemic events occurred in the RI-in-PN group, with 9 and 14 events in the non-RI-in-PN CVICU and SICU groups, respectively (P=0.405). There was no difference in the amount of dextrose needed for hypoglycemic events (P=0.456), and none of the PNs in the RI-in-PN groups were stopped for hypoglycemia. The time in the blood glucose range of 70-180 mg/dL was 77.1% in the RI-in-PN, 87.3%, and 74.3% in the non-RI-in-PN CVICU and SICU groups, respectively (P=0.081).

Conclusions: This early data analysis shows that RI-in-PN is a safe and effective option for critically ill patients. These findings unveil a potential prospective interventional study with a larger sample size evaluating appropriate modalities for controlling blood glucose in critically ill patients receiving PN.