Insulin aspart is better than human regular insulin in intensive therapy for critical care patients

Abstract

Objective To observe the efficacy and safety of insulin aspart in intensive insulin therapy of hyperglycemia in medical critically ill patients. Methods A total of 186 medical critically ill patients with fasting blood glucose (10.8±2.3)mmol/L were divided into multiple daily insulin(MDI) group(n=90) and continous subcutaneous insulin infusion (CSII) group(n=96), both groups were divided into insulin aspart subgroup and human regular insulin subgroup randomly.Bonus dosage was offered by insulin aspart or human regular insulin in MDI group, base dosage was offered by Glagine.Bonus and base dosage were offered by insulin aspart or human regular insuline in CSII group.The dosage of insulin was adjusted according to multi–points blood glucose levels. The course of intensive insulin therapy was 7 days with blood glucose levels 4.4~8.3 mmol/L, and it was changed to regular insulin therapy after 7 days with blood glucose levels 4.4~11.1 mmol/L. Average blood glucose level, blood glucose standard deviation, the equation of the highest and the lowest blood glucose level in one day, percentage of total hypoglycemia and serious hypoglycemia, average insulin dosage, decline of blood CRP level and APACHEⅡ during 7 days, and mortality during twenty eight days were observed. Results (1) There were no statistical significance in difference on lab items before intensive insulin therapy in both subgroups. (2)Compared to human regular insulin subgroup, insulin aspart subgroup was lower in average blood glucose level. MDI group: (6.17±1.32) mmol/L vs (7.6±1.6) mmol/L; CSII group: (6.0±1.2) mmol/L vs (7.4±2.5) mmol/L, P 0.05 respectively). Conclusion Insulin aspart can better control average blood glucose and its variability, lower the percentage of hypoglycemia, save insulin dosage and relieve inflammation than human regular insulin in treating hyperglycemia of medical critically ill patients. Key words: Insulin aspart; Human regular insulin; Critical care patients; Stress–induced hyperglycemia; Intensive insulin therapy