Association Between the Use of Long-Acting Insulin and Hypoglycemia in Critically Ill Patients with Diabetes.

Introduction: Hypoglycemia in critically ill patients increases morbidity and mortality. Subcutaneous long-acting insulin (LAI) in patients without diabetes is associated with hypoglycemia in the SICU. However, limited evidence exists in patients with diabetes. Methods: This was a single-center, retrospective cohort study evaluating patients with T2DM who were admitted to the SICU for 24 h and received LAI in combination with sliding scale insulin (LAI + SSI) or sliding scale insulin (SSI) alone. The primary outcome was the incidence of hypoglycemia (BG < 70 mg/dL) in patients who received LAI + SSI or SSI. Secondary outcomes evaluated the number of glucose values across defined categories: hypoglycemia (54-70 mg/dL), severe hypoglycemia (<54 mg/dL), euglycemia (70-180 mg/dL), hyperglycemia (>180 mg/dL) and glycemic variability. Results: A total of 228 patients were included in the final analysis. The incidence of hypoglycemia occurred in 17.5% of patients in the LAI + SSI cohort and 18.4% in the SSI cohort (p = .86). After controlling for confounders, no differences were observed with LAI + SSI versus SSI for hypoglycemia (OR 1.09, 95% CI 0.46-2.6, p = .85). Secondary outcomes demonstrated no difference in total hypoglycemia (37 vs 31, p = .80), severe hypoglycemia (15 vs 34, p = .17) and euglycemia (1622 vs 1780, p = .22) in the LAI + SSI cohort compared to SSI alone. Hyperglycemia occurred more frequently with LAI + SSI. However, after adjusting for confounders there was no difference in hyperglycemia (OR 1.8, 95% CI 0.7-4.6, p = .22). No difference was observed in glycemic variability between LAI + SSI and SSI (26.5 vs 24.5, p = .21). Conclusion and Relevance: The addition of LAI to SSI in SICU patients with T2DM was not associated with an increased risk of hypoglycemia.

• Publication year

  2025

• Venue

  Journal of Intensive Care Medicine

• Publication date

  2025-09-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1177/08850666251371709PMID 40888642
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Hypoglycemia and hospital mortality in critically ill patients

  2025cited by this paper
• Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024: Executive Summary

  2024cited by this paper
• 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2025.

  2024cited by this paper
• Efficacy and Safety of Intensive Versus Nonintensive Supplemental Insulin With a Basal-Bolus Insulin Regimen in Hospitalized Patients With Type 2 Diabetes: A Randomized Clinical Study.

  2022cited by this paper
• Intravenous Insulin Infusion Protocol Compared With Subcutaneous Insulin for the Management of Hyperglycemia in Critically Ill Adults

  2019cited by this paper
• Association Between the Use of Long-Acting Insulin and Hypoglycemia in Nondiabetic Patients in the Surgical Intensive Care Unit

  2018cited by this paper
• Glycemic Control and Risk of Infections Among People With Type 1 or Type 2 Diabetes in a Large Primary Care Cohort Study

  2018cited by this paper
• Poor glycemic control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgery

  2016cited by this paper
• Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial

  2015cited by this paper
• Randomized Study Comparing a Basal-Bolus With a Basal Plus Correction Insulin Regimen for the Hospital Management of Medical and Surgical Patients With Type 2 Diabetes

  2013cited by this paper
• Subcutaneous versus intravenous insulin therapy for glucose control in non‐diabetic trauma patients. A randomized controlled trial

  2013cited by this paper
• Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery)

  2011cited by this paper
• A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients.

  2009cited by this paper
• Sliding scale insulin--time to stop sliding.

  2009cited by this paper
• Poor Glycemic Control is Associated with Increased Mortality in Critically Ill Trauma Patients

  2007cited by this paper
• Causes and consequences of hyperglycemia in critical illness

  2007cited by this paper
• Severe hypoglycemia in critically ill patients: Risk factors and outcomes*

  2007cited by this paper
• Perioperative glucose control in the diabetic or nondiabetic patient.

  2006cited by this paper
• Intensive Insulin Therapy in the Intensive Care Unit

  2006cited by this paper
• Management of diabetes and hyperglycemia in hospitals.

  2004cited by this paper
• Insulin resistance and hyperglycemia in critical illness: role of insulin in glycemic control.

  2004cited by this paper
• Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.

  2002cited by this paper
• Stress-induced hyperglycemia.

  2001cited by this paper
• Efficacy of sliding-scale insulin therapy: a comparison with prospective regimens.

  1994cited by this paper

• No citing papers are available for this paper.