Effects of continuous and subcutaneous insulin administration in order to maintain strict blood glucose regulation among critical care patients on mortality

Effects Of Continuous Intravenous and Subcutaneous Insulin Administration In Order To Maintain Strict Blood Glucose Regulation Among Critical Care Patients On Mortality Saygılı, Fatih MD Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıktan AD Correspondence: Fatih Saygılı, MD. DEUTF İç Hastalıkları A.D Balçova/İZMİR e-mail: fatih.saygili@deu.edu.tr Aim: Hyperglycemia, is a frequent metabolic disorder regardless of history of diabetes Strict blood glucose control was shown to highly reduce the mortality among critically ill patients with the study of Van den Berghe et al, published in 2001. The same procedure was applied to the medical intensive care unit (ICU) patients, but this did not bring any improvement on mortality. Hypoglycemic events occurring in the medical ICU was blamed to be the major cause to reduce the outcome benefits. We aimed to establish the strict blood glucose control by using Continuous Subcutaneous Insulin Infusion (CSII) Pump and compare the efficacy and security of this method versus continuous IV infusion method. Material and Method: The patients, followed up in the Dokuz Eylul University Hospital Medical ICU department between April and July 2006 were randomised into two groups; intravenous and the insulin pump group. Insulin therapy was administered to both groups according to the previously designed scale by our department, in order to maintain blood glucose levels between 80-1 10 m/dl. Results: There was no significant difference on mortality between insulin pump and the İV infusion group with numbers of nine and ten patients respectively. However the mean blood glucose level was found to be lower (116 mg/dl vs. 1 52 mg/dl) in the insulin pump group. This difference was accomplished by using lower doses of insulin for both bolus and basal infusion rates in the insulin pump group. Conclusion: Despite the low number of patients involved in our study, it can be suggested that the insulin pump method is at least as efficient as the IV infusion method.