Comparative Efficacy and Safety of Basal/Correctional Vs Basal/Bolus/Correctional Insulin Regimens in Medical Intensive Care Unit Patients Receiving Continuous Enteral Nutrition.

Background: While glycemic control is essential in critically ill patients, the optimal insulin regimen for patients receiving continuous enteral nutrition (CEN) is unknown.

Objective: This study compares glycemic control in basal/correctional vs basal/bolus/correctional insulin regimens in intensive care unit (ICU) patients receiving CEN.

Methods: This retrospective study included patients ≥18 years old, admitted to the medical critical care service with administration of CEN and ≥20 units of insulin detemir daily for ≥48 hours. Patients receiving non-insulin hypoglycemic agents were excluded. The primary outcome was the comparison of glycemic control, assessed by mean blood glucose and percent of glucose checks in target range. Secondary outcomes included the comparison of hypoglycemia, hyperglycemic emergencies, and glycemic variability between groups.

Results: A total of 100 patients were included, with 50 patients per group. Mean blood glucose and percent of blood glucose checks in the target range were similar between basal/correctional and basal/bolus/correctional groups (204.2 vs 194.2 mg/dL, = 0.2433 and 37.8% vs 43.1%, = 0.3182, respectively). There were no differences in hypoglycemia or hyperglycemic emergencies. Among patients receiving ≥60 units of insulin daily, the basal/bolus/correctional regimen was associated with lower mean blood glucose (197.1 vs 248.5 mg/dL, < 0.0001) and increased glucose checks in target range (43.5% vs 9.1%, = 0.0040) without increased hypoglycemia.

Conclusion And Relevance: Among ICU patients requiring ≥20 units of insulin detemir daily while receiving CEN, basal/correctional and basal/bolus/correctional insulin regimens appear to offer similar glycemic control, but basal/bolus/correctional regimens may improve glycemic control in patients requiring ≥60 units of insulin daily.