Objective: To compare efficacy and safety in the treatment of hyperglycemia with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injection (MDI) in critical elderly patients.
Methods: Ninety-four elderly patients in critical condition with fasting glucose (10.3+/-2.5) mmol/L were randomly divided into CSII group (46 cases) and MDI group (48 cases). Soluble human insulin was used in both groups, and the treatment lasted for 7 days, and blood glucose level, average insulin dosage, percentage of hypoglycemia during 7 days, blood C-reacting protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) level and acute physiology and chronic health evaluation II (APACHE II) scores on the 7th day, and mortality during 28 days were observed.
Results: Compared with MDI group, blood glucose was better controlled [76.1% (35/46) vs. 33.3% (16/48)], percentage of fair control of blood glucose level was higher [21.7% (10/46) vs. 14.6% (7/48)], percentage of poor control of blood glucose level was lower [2.2% (1/46) vs. 52.1% (25/48)], percentage of hypoglycemia was lower [10.9% (5/46) vs. 22.9% (11/48)], average insulin dosage during 7 days was less [(40.1+/-6.3) U/d vs. (46.2+/-7.1) U/d], serum TNF-alpha level [(11.5+/-2.7) microg/L vs. (19.8+/-4.2) microg/L], IL-6 level [(78.3+/-5.1)microg/L vs.(141.4+/-6.2) microg/L] and CRP level [(53.1+/-3.3) mg/L vs. (72.1+/-4.0) mg/L] on the 7th day was lower, APACHE II score was lower on the 7th day [(6.0+/-1.4) scores vs. (11.6+/-1.0) scores], and 28-day mortality was lower in CSII group [4.3% (2/46) vs. 16.7% (8/48)]. All the above values showed statistically significant difference between two groups (all P < 0.05).
Conclusion: CSII can better control blood glucose and alleviate inflammatory response and improve prognosis in elderly critically ill patients.