Insulin Degludec in Critically Ill Patients With Type 2 Diabetes Mellitus: A Prospective Interventional Study.

Objective: Dysglycemia has deleterious outcomes on critically ill patients with diabetes mellitus (DM). Insulin degludec, an ultralong-acting insulin, is associated with lower rates of hypoglycemia and blood glucose (BG) variability in non-critically ill patients. The experience with insulin degludec in the intensive care units is lacking. This study aimed to assess the effect of insulin degludec on glycemic control in critically ill patients with type 2 DM.

Methods: A prospective, interventional study enrolled critically ill patients with type 2 DM. Subjects were started on insulin degludec plus insulin regular correctional doses. BG levels were assessed every 6 hours. The primary outcome was the percentage of BG levels within a target of 140 to 180 mg/dL. The secondary outcomes included the median BG levels, severe hypoglycemia rate, and BG variability.

Results: In total, 155 patients were enrolled. The percentage of BG levels within the target was 28.5%. The first day that the median of BG levels within target was on day 2 of insulin degludec therapy, which continued to be within the target for 1 week. Severe hypoglycemia developed in 5 patients (3.2%). The BG variability in the study was 26% using the coefficient of variation.

Conclusion: In critically ill patients with type 2 DM, one-fourth of BG levels were within the glycemic target (140-180 mg/dL) with insulin degludec plus insulin regular correctional doses. The median BG levels were in target starting the second day of insulin degludec therapy. The favorable BG variability using insulin degludec merits further investigation for effect on clinical outcomes.