Background:
Dysglycemia in critically ill patients is common, where 40% to 54% of patients were found to
be hyperglycemic on intensive care unit admission. Several randomized controlled trials (RCT)
were conducted to address the importance of glycemic control during critical illness on
patient's outcomes.
The American association of diabetes recommends initiation of insulin infusion for critically
ill patients aiming to target glucose levels 140-180 mg/dl. However, several limitations
prevent the use of insulin infusion in critically ill such as the requirements of frequent
blood glucose measurement and nursing staff workload, which in turn led to the use of the
subcutaneous rapid acting and basal insulin during critical illness. The evidence on the use
of subcutaneous insulin therapy compared to insulin infusion is mainly derived from
observational studies that showed conflicting results.
Multiple RCTs demonstrated the comparable efficacy of degludec versus glargine in blood
glycemic control and better safety profile in terms of nocturnal hypoglycemia and severe
hypoglycemia in the outpatient/inpatient diabetic population. Studies addressing the role,
safety, and efficacy of degludec in critically ill patients are lacking.
Study aim:
To assess the effectiveness of using insulin degludec as basal insulin in conjunction with
subcutaneous regular insulin sliding scale (ISS) in the glycemic control in critically ill
patients.