{"id":"https://openalex.org/W7214709393","doi":"https://doi.org/10.64898/2026.09.28.26364145","title":"Glargine-to-intravenous insulin dose ratio, rebound hyperglycemia and hypoglycemia after discontinuation of insulin infusion in critically ill adults: a retrospective cohort study","display_name":"Glargine-to-intravenous insulin dose ratio, rebound hyperglycemia and hypoglycemia after discontinuation of insulin infusion in critically ill adults: a retrospective cohort study","publication_year":2026,"publication_date":"2026-09-29","ids":{"openalex":"https://openalex.org/W7214709393","doi":"https://doi.org/10.64898/2026.09.28.26364145"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.28.26364145","doi":"https://doi.org/10.64898/2026.09.28.26364145","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.28.26364145","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.28.26364145.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"public-domain","license_id":"https://openalex.org/licenses/public-domain","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.28.26364145.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5153467378","display_name":"Lujun Shao","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I146516829","display_name":"Hirosaki University","ror":"https://ror.org/02syg0q74","country_code":"JP","type":"education","lineage":["https://openalex.org/I146516829"]},{"id":"https://openalex.org/I4210122818","display_name":"The Affiliated Taizhou People's Hospital of Nanjing Medical University","ror":"https://ror.org/02fvevm64","country_code":"CN","type":"healthcare","lineage":["https://openalex.org/I4210122818"]}],"countries":["CN","JP"],"is_corresponding":false,"raw_author_name":"Lujun Shao","raw_affiliation_strings":["Department of Intensive Care Unit, The Affiliated Taizhou People\u2019s Hospital of Nanjing Medical University, Taizhou 225300, China","Graduate School of Medicine, Hirosaki University, Hirosaki 036-8562, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Intensive Care Unit, The Affiliated Taizhou People\u2019s Hospital of Nanjing Medical University, Taizhou 225300, China","institution_ids":["https://openalex.org/I4210122818"]},{"raw_affiliation_string":"Graduate School of Medicine, Hirosaki University, Hirosaki 036-8562, Japan","institution_ids":["https://openalex.org/I146516829"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5153471535","display_name":"Yue Li","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210122818","display_name":"The Affiliated Taizhou People's Hospital of Nanjing Medical University","ror":"https://ror.org/02fvevm64","country_code":"CN","type":"healthcare","lineage":["https://openalex.org/I4210122818"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yue Li","raw_affiliation_strings":["Department of Intensive Care Unit, The Affiliated Taizhou People\u2019s Hospital of Nanjing Medical University, Taizhou 225300, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Intensive Care Unit, The Affiliated Taizhou People\u2019s Hospital of Nanjing Medical University, Taizhou 225300, China","institution_ids":["https://openalex.org/I4210122818"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5153488385","display_name":"Li Wang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210122818","display_name":"The Affiliated Taizhou People's Hospital of Nanjing Medical University","ror":"https://ror.org/02fvevm64","country_code":"CN","type":"healthcare","lineage":["https://openalex.org/I4210122818"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Li Wang","raw_affiliation_strings":["Department of Intensive Care Unit, The Affiliated Taizhou People\u2019s Hospital of Nanjing Medical University, Taizhou 225300, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Intensive Care Unit, The Affiliated Taizhou People\u2019s Hospital of Nanjing Medical University, Taizhou 225300, China","institution_ids":["https://openalex.org/I4210122818"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5054216241","display_name":"Wenbin Sun","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210122818","display_name":"The Affiliated Taizhou People's Hospital of Nanjing Medical University","ror":"https://ror.org/02fvevm64","country_code":"CN","type":"healthcare","lineage":["https://openalex.org/I4210122818"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Wenbin Sun","raw_affiliation_strings":["Department of Intensive Care Unit, The Affiliated Taizhou People\u2019s Hospital of Nanjing Medical University, Taizhou 225300, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Intensive Care Unit, The Affiliated Taizhou People\u2019s Hospital of Nanjing Medical University, Taizhou 225300, China","institution_ids":["https://openalex.org/I4210122818"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5054216241"],"corresponding_institution_ids":["https://openalex.org/I4210122818"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11623","display_name":"Hyperglycemia and glycemic control in critically ill and hospitalized patients","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11623","display_name":"Hyperglycemia and glycemic control in critically ill and hospitalized patients","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10560","display_name":"Diabetes Management and Research","score":0.0003000000142492354,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10401","display_name":"Diabetes Treatment and Management","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/glargine","display_name":"glargine","score":0.7789999842643738},{"id":"https://openalex.org/keywords/intravenous-insulin","display_name":"intravenous insulin","score":0.7919999957084656},{"id":"https://openalex.org/keywords/insulin-discontinuation","display_name":"insulin discontinuation","score":0.6759999990463257},{"id":"https://openalex.org/keywords/rebound-hyperglycemia","display_name":"rebound hyperglycemia","score":0.8510000109672546},{"id":"https://openalex.org/keywords/hypoglycemia","display_name":"hypoglycemia","score":0.9900000095367432},{"id":"https://openalex.org/keywords/basal-insulin-dose","display_name":"basal insulin dose","score":0.6420000195503235},{"id":"https://openalex.org/keywords/critical-illness","display_name":"critical illness","score":0.5429999828338623},{"id":"https://openalex.org/keywords/intensive-care-unit","display_name":"intensive care unit","score":0.6779999732971191},{"id":"https://openalex.org/keywords/cardiac-surgery","display_name":"cardiac surgery","score":0.5860000252723694},{"id":"https://openalex.org/keywords/glycemic-control","display_name":"glycemic control","score":0.4099999964237213},{"id":"https://openalex.org/keywords/insulin-infusion-rate","display_name":"insulin infusion rate","score":0.3319999873638153},{"id":"https://openalex.org/keywords/length-of-hospital-stay","display_name":"length of hospital stay","score":0.515999972820282}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9431999921798706},{"id":"https://openalex.org/C2780668416","wikidata":"https://www.wikidata.org/wiki/Q202758","display_name":"Hypoglycemia","level":3,"score":0.7749000191688538},{"id":"https://openalex.org/C2778715236","wikidata":"https://www.wikidata.org/wiki/Q55622662","display_name":"Discontinuation","level":2,"score":0.7174000144004822},{"id":"https://openalex.org/C2779920387","wikidata":"https://www.wikidata.org/wiki/Q417317","display_name":"Insulin glargine","level":4,"score":0.6978999972343445},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.6492999792098999},{"id":"https://openalex.org/C2779306644","wikidata":"https://www.wikidata.org/wiki/Q2002370","display_name":"Insulin","level":2,"score":0.6169000267982483},{"id":"https://openalex.org/C2776376669","wikidata":"https://www.wikidata.org/wiki/Q5094647","display_name":"Intensive care unit","level":2,"score":0.4596000015735626},{"id":"https://openalex.org/C42219234","wikidata":"https://www.wikidata.org/wiki/Q131130","display_name":"Anesthesia","level":1,"score":0.42969998717308044},{"id":"https://openalex.org/C2991859549","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Critically ill","level":2,"score":0.4058000147342682},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.3961000144481659},{"id":"https://openalex.org/C207103383","wikidata":"https://www.wikidata.org/wiki/Q3930246","display_name":"Hazard ratio","level":3,"score":0.37689998745918274},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.365200012922287},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.36469998955726624},{"id":"https://openalex.org/C555293320","wikidata":"https://www.wikidata.org/wiki/Q12206","display_name":"Diabetes mellitus","level":2,"score":0.35670000314712524},{"id":"https://openalex.org/C2778024521","wikidata":"https://www.wikidata.org/wiki/Q55639806","display_name":"Basal (medicine)","level":3,"score":0.3361999988555908},{"id":"https://openalex.org/C2781283889","wikidata":"https://www.wikidata.org/wiki/Q1130148","display_name":"Diabetic ketoacidosis","level":3,"score":0.3181000053882599},{"id":"https://openalex.org/C2987404301","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care","level":2,"score":0.3041999936103821},{"id":"https://openalex.org/C168563851","wikidata":"https://www.wikidata.org/wiki/Q1436668","display_name":"Randomized controlled trial","level":2,"score":0.30090001225471497},{"id":"https://openalex.org/C2780221984","wikidata":"https://www.wikidata.org/wiki/Q131191","display_name":"Body mass index","level":2,"score":0.29670000076293945},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.29170000553131104},{"id":"https://openalex.org/C2777180221","wikidata":"https://www.wikidata.org/wiki/Q3025883","display_name":"Type 2 diabetes","level":3,"score":0.2833000123500824},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.27720001339912415},{"id":"https://openalex.org/C119060515","wikidata":"https://www.wikidata.org/wiki/Q1916617","display_name":"Interquartile range","level":2,"score":0.2547000050544739},{"id":"https://openalex.org/C2775849729","wikidata":"https://www.wikidata.org/wiki/Q1130148","display_name":"Ketoacidosis","level":4,"score":0.2500999867916107}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.28.26364145","doi":"https://doi.org/10.64898/2026.09.28.26364145","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.28.26364145","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.28.26364145.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"public-domain","license_id":"https://openalex.org/licenses/public-domain","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.28.26364145","doi":"https://doi.org/10.64898/2026.09.28.26364145","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.28.26364145","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.28.26364145.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"public-domain","license_id":"https://openalex.org/licenses/public-domain","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":1.0}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7214709393.pdf","grobid_xml":"https://content.openalex.org/works/W7214709393.grobid-xml"},"referenced_works_count":37,"referenced_works":["https://openalex.org/W1708450707","https://openalex.org/W1898928487","https://openalex.org/W1966714873","https://openalex.org/W1967775031","https://openalex.org/W1982545756","https://openalex.org/W2000445173","https://openalex.org/W2012658469","https://openalex.org/W2022010805","https://openalex.org/W2027695687","https://openalex.org/W2054766632","https://openalex.org/W2061326496","https://openalex.org/W2071066672","https://openalex.org/W2113676816","https://openalex.org/W2115709314","https://openalex.org/W2118502261","https://openalex.org/W2130373985","https://openalex.org/W2153098857","https://openalex.org/W2154749408","https://openalex.org/W2158144637","https://openalex.org/W2163278718","https://openalex.org/W2251290047","https://openalex.org/W2275737843","https://openalex.org/W2302681494","https://openalex.org/W2735301415","https://openalex.org/W2743990039","https://openalex.org/W2757504960","https://openalex.org/W3106266207","https://openalex.org/W4211084754","https://openalex.org/W4247704066","https://openalex.org/W4281790366","https://openalex.org/W4313439128","https://openalex.org/W4391025076","https://openalex.org/W4417121386","https://openalex.org/W6903865039","https://openalex.org/W6941414102","https://openalex.org/W6960102814","https://openalex.org/W7140405555"],"related_works":["https://openalex.org/W2154749408","https://openalex.org/W4386111885","https://openalex.org/W1859721439","https://openalex.org/W4281891971","https://openalex.org/W2511797199","https://openalex.org/W3127697028","https://openalex.org/W3207106114","https://openalex.org/W2404647560","https://openalex.org/W78423688","https://openalex.org/W1522825492"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"When":[2],"intravenous":[3,46,75,307],"insulin":[4,13,47,76],"is":[5,21,329,349],"stopped":[6],"in":[7,86,154,188],"critically":[8,293],"ill":[9,294],"patients,":[10],"the":[11,38,44,61,98,101,108,113,161,189,216,227,239,305,316,333,343],"basal":[12,327],"dose":[14,104],"that":[15],"balances":[16],"rebound":[17,120,175,195,233,252,267,313],"hyperglycemia":[18,121,176,196,314],"against":[19],"hypoglycemia":[20,129,182,206,259],"uncertain,":[22],"because":[23],"randomized":[24,340],"trials":[25],"were":[26,141,172,309],"small":[27],"and":[28,128,179,204,253,282,320],"not":[29,224],"designed":[30],"to":[31,43,83,105,238,248,256,304,336],"quantify":[32],"this":[33,56],"trade-off.":[34,325],"We":[35],"examined":[36],"how":[37],"first":[39,102,217,317],"glargine":[40,85,103,272,301],"dose,":[41],"relative":[42,303],"preceding":[45,306],"requirement,":[48],"was":[49,97,164,191,223,234,268],"associated":[50,192,225,310],"with":[51,143,193,226,271,285,311],"both":[52],"outcomes.":[53],"Methods":[54],"In":[55,264,292],"retrospective":[57],"cohort":[58],"study":[59],"of":[60,78,100,221,243,346],"Medical":[62],"Information":[63],"Mart":[64],"for":[65,174,181],"Intensive":[66],"Care":[67],"IV":[68],"database":[69],"(2008\u20132022),":[70],"we":[71],"included":[72],"transitions":[73,153],"from":[74],"infusions":[77],"at":[79,274],"least":[80,275],"6":[81,115,218,318],"hours":[82,219,277,319],"subcutaneous":[84],"adults":[87],"without":[88],"diabetic":[89],"ketoacidosis":[90],"or":[91],"hyperosmolar":[92],"hyperglycemic":[93],"state.":[94],"The":[95,117],"exposure":[96],"ratio":[99,163,190,198,228,242],"24":[106,126],"times":[107],"mean":[109],"infusion":[110],"rate":[111],"over":[112],"final":[114],"hours.":[116],"primary":[118],"outcomes,":[119],"(glucose":[122,130],">180":[123],"mg/dL":[124,132],"within":[125,133,215],"hours)":[127,135],"<70":[131],"48":[134],"during":[136],"intensive":[137],"care":[138],"unit":[139],"follow-up,":[140],"analyzed":[142],"multivariable":[144],"Cox":[145],"models":[146],"after":[147,158,297,315],"multiple":[148],"imputation.":[149],"Results":[150],"Among":[151],"6,220":[152],"5,924":[155],"patients":[156],"(87.5%":[157],"cardiac":[159,298],"surgery),":[160],"median":[162],"0.41":[165],"(interquartile":[166],"range":[167],"0.30\u20130.46).":[168],"Kaplan\u2013Meier":[169],"cumulative":[170],"incidences":[171],"44.4%":[173],"(2,109":[177],"events)":[178,222],"6.4%":[180],"(211":[183],"events).":[184],"Each":[185],"0.1":[186],"increase":[187],"less":[194,269,312],"(hazard":[197],"0.96,":[199],"95%":[200],"confidence":[201],"interval":[202],"0.93\u20130.99)":[203],"more":[205,258,283,321],"(1.11,":[207],"1.04\u20131.18),":[208],"consistently":[209],"across":[210],"21":[211],"sensitivity":[212],"analyses.":[213],"Rebound":[214],"(57.6%":[220],"(0.99,":[229],"0.95\u20131.02),":[230],"whereas":[231],"later":[232],"(0.91,":[235],"0.86\u20130.96).":[236],"Standardized":[237],"cohort,":[240],"a":[241,323,339],"0.60":[244],"versus":[245],"0.40":[246],"corresponded":[247],"2.7":[249],"(0.6\u20134.9)":[250],"fewer":[251],"1.7":[254],"(\u22120.2":[255],"3.5)":[257],"episodes":[260],"per":[261],"100":[262],"transitions.":[263],"secondary":[265],"analyses,":[266],"frequent":[270,284],"given":[273,335],"2":[276],"before":[278],"discontinuation":[279],"(0.86,":[280],"0.77\u20130.96)":[281],"an":[286],"oral":[287],"diet":[288],"(1.49,":[289],"1.30\u20131.71).":[290],"Conclusions":[291],"adults,":[295],"mostly":[296],"surgery,":[299],"higher":[300],"doses":[302],"requirement":[308],"hypoglycemia,":[322],"gradual":[324],"Which":[326],"fraction":[328,345],"preferable":[330],"depends":[331],"on":[332],"weight":[334],"each":[337],"outcome;":[338],"trial":[341],"including":[342],"guideline-implied":[344],"about":[347],"0.30":[348],"warranted.":[350]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-09-30T00:00:00"}