Effect of insulin infusion line on glycaemic variability in a perioperative high dependency unit (HDU): a prospective randomised controlled trial

Abstract

Background: Glucose control is an important issue in post-operative patients. The objective here was to compare two insulin infusion lines by syringe pumps to assess the impact of medical devices on glycaemic variability in surgical patients under intensive insulin therapy. This open, prospective, single-centre randomised study was conducted in a fifteen-bed perioperative high dependency unit (HDU) in a university hospital. In total, 172 eligible patients receiving insulin therapy agreed to participate in the study. Subcutaneous continuous glucose monitoring was set up for all patients and an optimised system with a dedicated insulin infusion line for half of the patients.

Results: Eighty-six patients were infused via the optimised infusion line and 86 patients via the standard infusion line. No significant difference was found according to the glycaemic lability index score [mean difference between groups (95% CI): -0.09 (-0.34; 0.16), p = 0.49 after multiple imputation]. A glucose control monitoring system indicated a trend towards differences in the duration of hypoglycaemia (blood glucose level below 70 mg dl^-1 (3.9 mmol l^-1) over 1000 h of insulin infusion (9.7 ± 25.0 h in the standard group versus 4.4 ± 14.8 h in the optimised group, p = 0.059) and in the number of patients experiencing at least one hypoglycaemia incident (25.7 vs. 12.9%, p = 0.052). Time in the target range was similar for both groups.

Conclusions: The use of optimised infusion line with a dedicated insulin infusion line did not reduce glycaemic variability but minimised the incidence of hypoglycaemia events. The choice of the medical devices used to infuse insulin seems important for improving the safety of insulin infusion in perioperative HDU.

Keywords: Drug delivery systems/instrumentation; Infusion pumps; Infusions, intravenous/instrumentation; Insulin; Perioperative care.

Fig. 1

Schematic representation of the two infusion lines assessed. a Standard insulin infusion line using a six-stopcock manifold connected to the distal line of a multilumen central venous catheter by 150 cm tubing (RPB6315, Cair LGL, Lissieu, France). b Optimised insulin infusion line using a multilumen device (Edelvaiss Multiline-8, Doran International, Toussieu, France)

Fig. 2

Study flow chart

Fig. 3

Mean ±2 standard deviations of blood glucose values measured by iPro2 over 48 h according to the insulin infusion lines