(302) The Effectiveness and Safety of Insulin Degludec in Critically Ill Patients With Diabetes Mellitus

Introduction: The deleterious effect of dysglycemia is well described in patients admitted to the intensive care unit (ICU), including patients with diabetes mellitus (DM). Insulin Degludec (IDeg), a long-acting insulin associated with lower ‎rates of hypoglycemia and blood glucose (BG) variability in various populations, with limited experience in ‎critically ill patients. We aimed to assess the effectiveness and safety of IDeg in critically ill patients with DM.‎

Methods: A prospective, single-center, interventional study included critically ill patients with DM, with two ‎BG levels ≥ 180 mg/dL. Patients received a daily dose of IDeg plus a regular insulin ‎sliding scale (RISS), and BG levels were assessed every 6 hours. The percentage of BG level within a target of 140-180 mg/dL was examined as a primary endpoint. Other glycemic targets, rate of hypoglycemia and BG ‎variability were evaluated as secondary endpoints.

Results: A total of 155 patients were enrolled, with median APACHE II and SOFA scores of 19 (interquartile range [IQR] 12-25) ‎and 7 (IQR 5-9), respectively. The most frequent indication for ICU admission was postoperative ‎care (n=66, 42.6%). The median duration of IDeg ‎therapy was 3 (IQR 1-7) days. The percentage of BG level within a target of 140-180 mg/dL was ‎‎28.4%, and the daily median BG levels were within target starting from the second day of IDeg therapy. Patients' age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.02, P=0.000), prehospitalization insulin use (OR 0.81, 95% CI 0.66-0.98, P=0.04), the median RISS dose per kg (OR 0.001, 95% CI ‎‎0.0003-0.007, P= 0.005), and steroids use (OR 0.73, 95% CI 0.59-0.91, P= 0.005) were ‎independently associated with BG levels in target, according to multivariable regression ‎analysis. When the glycemic target was set to Diabetes Canada Clinical Practice Guidelines (110-180 mg/dL), 44% of BG levels were within target. Severe hypoglycemia ‎experienced by 5 (3.2%) patients, and the coefficient of variation (CV) in BG ‎was 26%, with 112 (72.3%) patients having a CV of < 30%.

Conclusions: More than one-fourth of BG levels in critically ill patients with DM are in glycemic target with IDeg therapy, with low glycemic variability and an acceptable rate of hypoglycemia. IDeg could be used in selected patients with DM in the ICU.