Glargine insulin: an alternative to regular insulin for glycemic control in critically ill patients

The objective of this study was to determine the efficacy and safety of subcutaneous (s.c.) once-daily (OD) glargine insulin, a long-acting insulin, in comparison with a s.c. regular insulin, based on a protocolized sliding scale regimen for achieving glycemic control in patients admitted to the ICU.

One hundred patients admitted to the ICU with an admission capillary blood glucose (CBG) >150 mg/dl (8.3 mmol/l) were involved in this prospective, randomized study. Patients with age <18 years, pregnancy, shock, requiring continuous intravenous insulin infusion, renal failure were excluded. Patients were randomly assigned to receive either s.c. glargine insulin 10 U (CBG ≤ 9.9 mmol/l) or 18 U (CBG ≥ 10.1 mmol/l) s.c. OD (Group G, n = 50), or s.c. regular insulin based on a 6-hourly sliding scale (Group R, n = 50). CBGs were recorded at 6-hour intervals up to 96 hours or until ICU discharge, whichever was earlier. The target CBG in both groups was <150 mg/dl (8.3 mmol/l). Patients in group G received rescue doses of regular insulin, as required. Demographic characteristics, mean and median CBG, and episodes of hypoglycemia were studied.

OD s.c. glargine insulin is a safe and effective alternative to regular insulin for glycemic control in critically ill patients.