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Cited by 14Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchDiabetes Treatment and Management

Effect of the concomitant use of subcutaneous basal insulin and intravenous insulin infusion in the treatment of severe hyperglycemic patients

Open access
Lim, Yejee, Ohn, Jung Hun, Jeong, Joo, Ryu, Jiwon, Kim, Sun-wook, Cho, Jae Ho, Park, Hee-Sun, Kim, Hye Won +5 more·2022·Endocrinology and Metabolism
DOI 10.3803/enm.2021.1341PMC PMC9262694
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Abstract

Background: No consensus exists regarding the early use of subcutaneous (SC) basal insulin facilitating the transition from continuous intravenous insulin infusion (CIII) to multiple SC insulin injections in patients with severe hyperglycemia other than diabetic ketoacidosis. This study evaluated the effect of early co-administration of SC basal insulin with CIII on glucose control in patients with severe hyperglycemia.Methods: Patients who received CIII for the management of severe hyperglycemia were divided into two groups: the early basal insulin group (n=86) if they received the first SC basal insulin 0.25 U/kg body weight within 24 hours of CIII initiation and ≥4 hours before discontinuation, and the delayed basal insulin group (n=79) if they were not classified as the early basal insulin group. Rebound hyperglycemia was defined as blood glucose level of >250 mg/dL in 24 hours following CIII discontinuation. Propensity score matching (PSM) methods were additionally employed for adjusting the confounding factors (n=108).Results: The rebound hyperglycemia incidence was significantly lower in the early basal insulin group than in the delayed basal insulin group (54.7% vs. 86.1%), despite using PSM methods (51.9%, 85.2%). The length of hospital stay was shorter in the early basal insulin group than in the delayed basal insulin group (8.5 days vs. 9.6 days, P=0.027). The hypoglycemia incidence did not differ between the groups.Conclusion: Early co-administration of basal insulin with CIII prevents rebound hyperglycemia and shorten hospital stay without increasing the hypoglycemic events in patients with severe hyperglycemia.

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  • Emerging data from studies in people with hyperglycemia with and without diabetic ketoacidosis (DKA) show that the administration of a low dose (0.15-0.3 units/kg) of basal insulin analog in addition to intravenous insulin infusion may reduce the duration of insulin infusion and length of hospital stay and prevent rebound hyperglycemia without increased risk of hypoglycemia.

    “Emerging data from studies in people with hyperglycemia with and without diabetic ketoacidosis (DKA) show that the administration of a low dose (0.15-0.3 units/kg) of basal insulin analog in addition to intravenous insulin infusion may reduce the duration of insulin infusion and length of hospital stay and prevent rebound hyperglycemia without increased risk of hypoglycemia (64)(65)(66)(67).”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [66]

    The Results and Discussion report less rebound hyperglycemia in both DKA/HHS and non-DKA/HHS subgroups, a shorter hospital stay with 0.25 U/kg basal insulin, and no increase in hypoglycemic events. The Discussion explicitly says the addition of basal insulin did not shorten insulin-infusion duration in this study; that part of the multi-citation claim is not supported by this source. (LLM, conf=0.92)

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  • Administration of a low dose of basal insulin analog in addition to intravenous insulin infusion early in treatment may prevent rebound hyperglycemia without increased risk of hypoglycemia.

    “Studies have reported that the administration of a low dose of basal insulin analog in addition to intravenous insulin infusion early in the course of treatment may prevent rebound hyperglycemia without increased risk of hypoglycemia (64-66,179).”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [66]

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Research works printed but not linked: 1

  1. [17]Holt RIG Textbook of diabetes 4th ed Oxford Blackwell Publishing Ltd 2010 Chapter 34, Acute metabolic complications of diabetes: diabetic ketoacidosis and hyperosmolar hyperglycemia 546 52

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Authors
Lim, Y., Ohn, J. H., Jeong, J., Ryu, J., Kim, S.-W., Cho, J. H., Park, H.-S., Kim, H. W., Lee, J., Kim, E. S., Kim, N.-H., Jo, Y. H., & Jang, H. C.
Affiliations
  • Seoul National University Bundang Hospital (KR)
  • Seoul National University (KR)
Corresponding author
Jang, Hak Chul
ORCID
Venue
Endocrinology and Metabolism
Publisher
Korean Endocrine Society
Published
2022-06-30
Volume
37
Issue
3
Pages
444-454
ISSN
  • 2093-596X (ISSN-L)
  • 2093-5978
DOI
10.3803/enm.2021.1341
PMC
PMC9262694
OpenAlex
W4281891971
Cited by
14
References
28
Citations by year
2026: 2 · 2025: 6 · 2024: 3 · 2023: 1 · 2022: 2
FWCI
2.22
Type
journal article
Language
en
Open access
Licence
Locations
  • Endocrinology and Metabolism (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Seoul National University Open Repository (Seoul National University) (submittedVersion)
Funders
SNUBH Research Fund (14-2019-027)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
severe hyperglycemia, continuous intravenous insulin infusion, rebound hyperglycemia, glycemic control, hypoglycemia, length of hospital stay, critically ill patients
MeSH terms
Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Diabetic Ketoacidosis

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