Comparison of the Safety and Efficacy of Continuous Insulin Infusion Versus Intermittent Insulin Bolus in the Management of Hyperglycemia in Critically Ill Patients

Muhammad Rafi Ismail; Wahaj ul  Hassan; Fuad Ahmad  Siddiqi; Abid  Sharif; Taimoor  Ashraf; Fatima  Masood

doi:10.51253/pafmj.v76i6.13316

Authors

Muhammad Rafi Ismail Department of General Medicine, Combined Military Hospital Peshawar/National University of Medical Sciences (NUMS) Pakistan
Wahaj ul Hassan Department of General Medicine, Combined Military Hospital Peshawar/National University of Medical Sciences (NUMS) Pakistan
Fuad Ahmad Siddiqi Department of General Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Abid Sharif Department of General Medicine, Combined Military Hospital Peshawar/National University of Medical Sciences (NUMS) Pakistan
Taimoor Ashraf Department of Ophthalmology, Combined Military Hospital Peshawar/National University of Medical Sciences (NUMS) Pakistan
Fatima Masood Department of General Medicine, Combined Military Hospital Peshawar/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i6.13316

Keywords:

Critical Care, Hyperglycemia, Insulin Infusion, Intermittent insulin bolus, Intensive Care Unit

Abstract

Objective: To compare the efficacy and safety of intravenous continuous Insulin infusion (CII) versus Intermittent Insulin Bolus (IIB) in managing blood glucose levels in critically ill patients.

Study Design: Quasi-experimental study.

Place and Duration of Study: Intensive care units (ICUs) of a tertiary care hospital from Apr to Sep 2024.

Methodology: A total of 70 critically ill patients of either sex; age ≥18 years and capillary blood glucose ≥180mg/dL were equally distributed into CII (Group-A) and IIB (Group-B). The patients who did not survive within the first 48 hours, pregnant women, patients with hemodynamic instability (mean arterial blood pressure <65 mmHg), necessitating renal replacement therapy or those receiving palliative care were excluded. Descriptive statistics were used to calculate percentage, frequencies and Mean±SD. Comparison between variables were made by applying independent sample t-test along with chi-square test for categorical. The p-value of <0.05 was considered statistically significant.

Results: There were no significant differences in baseline characteristics between the two groups. The CII (Group-A) achieved significantly lower final blood sugar levels compared to the IIB (Group-B) (p=0.04). The initial and final insulin doses were significantly lower in the Group-A (p<0.001). No significant differences were observed in hypoglycemia incidence while it was observed Group-A had a wider spread of ICU stay durations, including longer stays up to 7 days, whereas Group-B had shorter spread and more concentrated ICU stays.

Conclusion: Continuous Intravenous Insulin infusion provides superior glycemic control, reduces glucose variability, and lowers infection risk compared to Intermittent Insulin Bolus in critically ..

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