1050

Abstract

Introduction: Insulin glargine and insulin NPH are both routinely utilized in the management of hyperglycemia in critically ill patients. Currently there is no safety or efficacy data to support the use of one agent over the other. Hypothesis: Insulin glargine and insulin NPH will be equally safe and effective for hyperglycemic management in critically ill patients as defined by number of hypoglycemic events and achievement of target blood glucose (BG). Methods: Critically ill adult patients admitted to Intensive Care Unit (ICU) requiring long-acting insulin for management of hyperglycemia were prospectively identified. Outcomes were compared between patients who received insulin glargine and insulin NPH. Safety was evaluated by comparing hypoglycemic (BG <70 mg/dL) and severe hypoglycemic (BG <40 mg/dL) episodes. Efficacy (BG <180 mg/dL) was evaluated with mean BG readings, percentage of BG readings >180 mg/dL, and 24 hour sliding scale insulin (SSI) requirements. Data were recorded until long-acting insulin was discontinued, patient transferred out of ICU, or for up to 14 days following insulin initiation, whichever occurred first. Data reported as median (IQR). Pearson’s chi-square and Mann Whitney U tests were utilized for dichotomous and continuous data, respectively. Results: Demographics were similar between insulin glargine (N=13) and insulin NPH (N=11) groups, including age, history of diabetes, and reason for ICU admission. Preliminary results show no difference in number of patients with hypoglycemic episodes [glargine=2, NPH=5; p=0.334] and no difference in number of patients with severe hypoglycemia [glargine=1, NPH=1; p=0.334]. One patient receiving glargine developed severe hypoglycemia (4 episodes) compared to one patient receiving NPH (1 episode). The glargine group had similar mean BG readings [150(147-201) vs 150(140-184); p=0.468] and percent of BG readings >180 mg/dL [30(12-63) vs 29(10-38); p=0.862] as the NPH group. Mean daily SSI requirements were the same at 4 units per day. There was no difference in ICU or hospital LOS. Conclusions: Preliminary results suggest insulin glargine and insulin NPH are equally safe and effective for the management of hyperglycemia in critically ill patients.