Pilot study of the efficacy and safety of different insulin infusion dilutions for blood glucose control in ICU patients
Abstract
Background: Hyperglycemia due to insulin resistance is common in critically ill patients, including those without pre‑existing diabetes, and is associated with increased mortality. This study aimed to compare the efficacy and safety of two insulin infusion diluents for blood glucose control in ICU patients.
Methods: In this single‑blinded randomized controlled trial conducted at seven ICU sites in Hospital Pakar Universiti Sains Malaysia (USM) between 1 December 2023 and 30 September 2024, 74 patients were enrolled and randomized to receive insulin diluted with either Gelafundin or normal saline (standard care). Blood glucose levels were recorded at baseline (0 h), 2 h, and 6 h after initiation of insulin infusion. Repeated‑measures ANOVA was used for analysis, with statistical significance set at P < 0.05.
Results: Mean blood glucose levels were higher in the normal saline (NS) group than in the Gelafundin group at baseline [14.50 mmol/L (12.09–14.33) vs 12.64 mmol/L (10.76–14.52), P = 0.014], at 2 h [13.86 mmol/L (10.86–16.86) vs 11.27 mmol/L (8.77–13.77), P = 0.014], and at 6 h [11.28 mmol/L (8.08–14.48) vs 8.27 mmol/L (6.87–9.67), P < 0.001]. A significant group‑by‑time interaction in blood glucose levels was observed [F (1,72) = 25.13, P < 0.001]. Both groups showed significant reductions in blood glucose from baseline to 6 h (NS: −3.21 mmol/L, 95% CI −5.17 to −1.25, P = 0.001; Gelafundin: −4.37 mmol/L, 95% CI −5.24 to −3.50, P < 0.001). Twenty‑eight‑day mortality was similar between groups (NS: 16.2%; Gelafundin: 18.9%; P = 0.760). Conclusion: Insulin diluted with Gelafundin achieved greater short‑term reductions in blood glucose levels than insulin diluted with normal saline in critically ill patients, without differences in 28‑day mortality between groups.