Fig. 1Patient disposition. CII, computerized intravenous insulin infusion; BG, blood glucose.
Fig. 2The mean glucose levels and insulin doses in good and poor responder groups of the cases using the computerized intravenous insulin infusion protocol during the 48 hours of intravenous insulin infusion. (A) Mean glucose level versus time mapped hourly for the initial 48 hours. (B) Insulin doses versus time mapped hourly for the initial 48 hours. Error bars indicate interquartile range. Numbers below each panel indicate the number of subjects for each time point. In panel B, the insulin infusion rates of good responders include data of a case in which insulin infusion at a rate of 8 to 10 U/hr was abruptly stopped at 44th hour.
Fig. 3Distribution of the time required to reach the target ranges with the computerized intravenous insulin infusion (CII) protocol and additional insulin infusion at early glycemic predicting points. (A) Good responder group. (B) Poor responder group. (C) Reduction in time required to reach a glucose range of 70 to 180 mg/dL. Box and whisker plots indicate median, interquartile range, and range.
Table 1Baseline characteristics of all the cases of the computerized
intravenous insulin infusion protocol targeting blood glucose 140 to 180 mg/dL (n=105)
Characteristic |
Value |
Age, yr |
63±14 |
Sex, male/female |
64 (61)/41 (39) |
BMI, kg/m2
|
23.89 (21.46–26.81) |
ICU/non-ICU patients |
43 (41)/62 (59) |
Duration of diabetes, yr |
5.50 (0.00–15.00) |
Type of diabetes |
|
Type 1 diabetes mellitus |
3 (2.9) |
Type 2 diabetes mellitus |
87 (82.9) |
Steroid-induced or post-transplant |
15 (14.3) |
Prior treatment of diabetes |
|
Oral glucose-lowering agents only |
36 (34.3) |
Insulin with or without oral agents |
38 (36.2) |
None or newly diagnosed diabetes |
31 (29.5) |
Chronic kidney disease (eGFR <60 mL/min/1.73 m2) |
31 (29.5) |
Reason for IV insulin therapy |
|
Perioperative |
45 (42.9) |
Continuous enteral feeding |
20 (19.0) |
Diabetic ketoacidosis |
10 (9.5) |
NPO for other reasonsa
|
30 (28.6) |
HbA1c (n=87), % |
8.5±2.4 |
C-peptide (n=36), ng/mL |
2.22 (1.06–4.20) |
Table 2Clinical characteristics of the good and poor responders in cases using the computerized insulin infusion protocol according to time required to achieve a glucose range of 70 to 180 mg/dL
Characteristic |
Good responder: <6.0 hr (n=41) |
Poor responder: ≥6.0 hr (n=50) |
P value |
Age, yr |
68.00 (55.00–76.50) |
66.00 (52.75–72.50) |
0.435 |
Sex, male/female |
24 (58.5)/17(41.5) |
33 (66.0)/17 (34.0) |
0.464 |
ICU/non-ICU patients |
13 (31.7)/28 (68.3) |
28 (56.0)/22 (44.0) |
0.020 |
BMI, kg/m2
|
24.20 (20.96–25.84) |
23.67 (21.05–26.95) |
0.646 |
Prior diagnosis of diabetes |
32 (78.0) |
32 (64.0) |
0.144 |
Duration of diabetes |
5.50 (0.25–18.50) |
4.00 (0.00–12.25) |
0.259 |
Type of diabetes |
|
|
0.549 |
Type 1 diabetes mellitus |
1 (2.4) |
2 (4.0) |
Type 2 diabetes mellitus |
35 (85.4) |
38 (76.0) |
Steroid-induced diabetes |
5 (12.2) |
10 (20.0) |
Prior treatment for diabetes |
|
|
0.005 |
Oral agents only |
19 (46.3) |
9 (18.0) |
Insulin±oral agents |
14 (34.1) |
18 (36.0) |
None |
8 (19.5) |
23 (46.0) |
Chronic kidney disease (eGFR <60 mL/min/1.73 m2) |
13 (31.7) |
15 (30.0) |
0.861 |
Reason for insulin infusion |
|
|
0.002 |
NPO for operation |
23 (56.1) |
9 (18.0) |
Continuous enteral feeding |
7 (17.1) |
13 (26.0) |
Diabetic ketoacidosis |
2 (4.9) |
7 (14.0) |
NPO for other cause |
9 (22.0) |
21(42.0) |
HbA1c, % |
8.21±2.38 |
8.51±2.35 |
0.585 |
C-peptide, ng/mL |
2.14 (1.78–3.59) (n=7) |
2.44 (1.09–4.56) (n=24) |
1.000 |
Table 3Factors independently associated with delayed achievement of a glucose range of 70 to 180 mg/dL
Factor |
Adjusted odds ratio (95% CI) |
P value |
Model 1 |
|
|
Initial blood glucose |
1.017 (1.007–1.027) |
0.001 |
Prior treatment for diabetes |
|
|
Oral agents only |
Reference |
|
Insulin±oral agents |
2.355 (0.708–7.837) |
0.163 |
None |
6.751 (1.924–23.681) |
0.003 |
Model 2 |
|
|
Initial blood glucose |
1.027 (1.011–1.043) |
0.001 |
Change in blood glucose level at 2 hr (blood glucose at 2 hr-initial blood glucose) |
1.019 (1.002–1.036) |
0.026 |
Change in insulin infusion rate from baseline at 3 hr (insulin infusion rate at 3 hr–initial insulin infusion rate) |
1.747 (1.058–2.885) |
0.029 |