49 Comparing Intravenous & Subcutaneous Insulin Regimens for Management of Hyperglycemia in Adult Burn Patients

Abstract Introduction Burn patients are at an increased risk of hyperglycemia due to metabolic, anabolic, and treatment-related factors. Studies in burn patients have targeted goal blood glucose (BG) values ranging from 80–140 mg/dL. Our study aimed to evaluate current management of hyperglycemia in burn patients and to develop a treatment protocol in this population. Methods A retrospective study of patients admitted between 10/2016 - 8/2019 was conducted. Eligible patients were at least 18 years old, admitted within 48 hours following injury, and admitted for either thermal, chemical, or electrical burn, frostbite, or inhalation injury. The primary outcome was glycemic control, defined as percent of time spent within our predefined BG goal range of 90–130 mg/dL using a time-weighted BG (TWBG) level. Insulin regimens were compared to determine the most effective modality for achieving this goal. Additional secondary outcomes included consequences of hypoglycemia, complications of poor glycemic control, length of stay, and in-hospital mortality. Results A total of 68 patients were evaluated, and 48 met inclusion criteria. Majority of patients were male (73%), with a mean (SD) age 60 (16) years, median (IQR) TBSA 10% (4,19), and median (IQR) baseline HbA1c 6.6% (5.6,8.2). Twenty-four (50%) patients did not have a history of diabetes. Patients spent a median (IQR) 38% (20,61) of days in goal range. Twelve patients (25%) had a TWBG level between 90–130 mg/dL. Overall, the median (IQR) TWBG level for all 48 patients was 140 mg/dL (132,160). Majority of patients were either on an insulin infusion (60%) or basal + sliding scale insulin (SSI) (51%). Patients that were on insulin infusions were controlled for a median (IQR) 75% (50,83) of days compared to patients treated using basal + SSI 20% (0,40) of days (p< 0.01). Other regimens are included in the table below. No patients were hypoglycemic (BG less than 70 mg/dL) based on TWBG. Conclusions The majority of patients in this study were not within goal BG range during their hospitalization. Patients were primarily managed by an insulin infusion or basal + SSI. However, the most appropriate regimen appears to be an insulin infusion or basal + bolus + SSI.