Comparing Safety Outcomes of Weight-Based Versus Non-Weight-Based Insulin Infusion Protocols

Introduction: Hyperglycemia has a well-defined association with increased risk of inpatient morbidity and mortality. The 2024 American Diabetes Association Guidelines recommend to initiate or intensify an insulin regimen in cases of hyperglycemia and to target a blood glucose of 140-180 mg/dL in critically ill patients. Hypoglycemia associated with the initiation or intensification of insulin in these patients is also a risk for morbidity and mortality. There are varying guideline recommendations on whether to utilize a weight-based or non-weight based insulin infusion protocol in this scenario. The goal of this study was to compare the safety of both a weight-based and non-weight-based insulin infusion protocol used within the same health system.


Methods: In this multicenter, retrospective medication use evaluation, patients who received either a weight-based insulin infusion or a non-weight-based insulin infusion between September 1, 2022 and August 21, 2024 were screened for inclusion. The primary outcome of the evaluation was the incidence of hypoglycemia, defined as a blood glucose value less than 70 mg/dL. Secondary outcomes included ICU and total hospital length of stay, the incidence of hyperglycemia following treatment initiation, the incidence of severe hypoglycemia, and the percentage of blood glucose values between 70 and 180 mg/dL.


Results: A total of 228 patient encounters for the weight-based protocol and 455 patient encounters for the non-weight-based protocol were identified. Fifty patient encounters from each group were chosen at random to be included in the study. There were eight patients (16%) who experienced hypoglycemia in the weight-based cohort compared to nine patients (18%) in the non-weight-based cohort (p = 0.79). The non-weight-based cohort had a higher median percentage of blood glucose values between 70 and 180 mg/dL (70.6% vs. 47.4%, p = 0.006) and a shorter median hospital length of stay (3.0 days vs. 4.0 days, p = 0.019) compared to the weight-based cohort. Other secondary outcomes were similar between the two groups.


Conclusions: There was no difference in hypoglycemia incidence seen between the two protocols. Due to the small sample size included in this study, larger studies should be conducted to confirm this finding.