Inpatient Glycemic Control With Sliding Scale Insulin in Noncritical Patients With Type 2 Diabetes: Who Can Slide?

2021 ◽  
Vol 16 (8) ◽  
Author(s):  
Alexandra L Migdal ◽  
Charlie Fortin-Leung ◽  
Francisco Pasquel ◽  
Heqiong Wang ◽  
Limin Peng ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Primary Outcome ◽  
Charlson Comorbidity Index Score ◽  
Viable Option ◽  
Health Records ◽  
Mild Hyperglycemia ◽  
Sliding Scale ◽  
Comorbidity Index

OBJECTIVE: Despite clinical guideline recommendations, sliding scale insulin (SSI) is widely used for the hospital management of patients with type 2 diabetes (T2D). We aimed to determine which patients with T2D can be appropriately managed with SSI in non–critical care settings. METHODS: We used electronic health records to assess inpatient glycemic control in medicine and surgical patients treated with SSI according to admission blood glucose (BG) concentration between June 2010 and June 2018. Primary outcome was the percentage of patients with T2D achieving target glycemic control, defined as mean hospital BG 70 to 180 mg/dL without hypoglycemia <70 mg/dL during SSI therapy. RESULTS: Among 25,813 adult patients with T2D, 8,095 patients (31.4%) were treated with SSI. Among patients with admission BG <140 mg/dL and BG 140 to 180 mg/dL, 86% and 83%, respectively, achieved target control without hypoglycemia, as compared with only 18% of those with admission BG ≥250 mg/dL (P < .001). After adjusting for age, gender, body mass index (BMI), race, Charlson Comorbidity Index score, and setting, the odds of poor glycemic control increased with higher admission BG (BG 140-180 mg/dL: odds ratio [OR], 1.8; 95% CI, 1.5-2.2; BG 181-250 mg/dL: OR, 3.7; 95% CI, 3.1-4.4; BG >250 mg/dL: OR, 7.2; 95% CI, 5.8-9.0), as compared with patients with BG <140 mg/dL. A total of 1,192 patients (15%) treated with SSI required additional basal insulin during hospitalization. CONCLUSION: Most non–intensive care unit patients with admission BG <180 mg/dL treated with SSI alone achieve target glycemic control during hospitalization, suggesting that cautious use of SSI may be a viable option for certain patients with mild hyperglycemia.

Effects of sliding scale insulin use on glycemic control and length of stay in hospitalized patients with Type 2 diabetes mellitus

Therapy ◽  
2004 ◽  
Vol 1 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Samy I McFarlane ◽  
Fadi El-Atat ◽  
Jonathan Castro ◽  
John Shin ◽  
Linda Joseph ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Length Of Stay ◽  
Hospitalized Patients ◽  
Sliding Scale ◽  
Insulin Use

70/30 Insulin Algorithm Versus Sliding Scale Insulin

2005 ◽  
Vol 39 (10) ◽  
pp. 1606-1610 ◽  
Author(s):  
J Megan Schoeffler ◽  
Dennis AK Rice ◽  
Douglas G Gresham
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Medical Literature ◽  
Pilot Trial ◽  
Comparative Trial ◽  
Control Blood Glucose ◽  
Sliding Scale ◽  
Blood Glucose Concentrations

BACKGROUND: The medical literature supports the fact that sliding scale dosing of insulin is an ineffective means to control blood glucose concentrations. Despite this, many clinicians still use sliding scale insulin (SSI) regimens. A better tool for controlling hyperglycemia is clearly needed. OBJECTIVE: To compare the efficacy of an algorithm using 70/30 insulin with traditional SSI dosing for glycemic control in hospitalized patients with type 2 diabetes. METHODS: A prospective, cohort, comparative trial was conducted at a 644-bed, 2-hospital, regional referral health system. Patients were screened for enrollment based on orders received in the pharmacy for sliding scale dosing of insulin. Patients were treated either following an algorithm using 70/30 insulin twice daily or traditional SSI dosing as written by the prescribing physician. RESULTS: Twenty patients with type 2 diabetes were involved in this pilot trial: 10 were treated with the 70/30 insulin algorithm and 10 received a physician-determined traditional SSI regimen. Patients treated based on the 70/30 insulin algorithm achieved better glycemic control (p = 0.042). No difference between the groups was detected in the average number of insulin units administered, insulin injections, or days patients spent on their respective insulin regimens. CONCLUSIONS: Glycemic control with the 70/30 insulin algorithm was superior to traditional SSI dosing.

Assessment of Glycemic Control in Veterans With Chronic Obstructive Pulmonary Disease and Type 2 Diabetes Mellitus on Inhaled Corticosteroid Therapy

2020 ◽  
pp. 089719002093687
Author(s):  
Madison P. Lempp ◽  
Meredith A. Sigler ◽  
Adebola A. Adesoye ◽  
Anusha Ponnuru ◽  
Courtney E. Duval
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Obstructive Pulmonary Disease ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Primary Outcome ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease

Objective To determine if the use of inhaled corticosteroid (ICS) therapy affects glycemic control in patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM). Background Studies have shown mixed evidence on the association between ICS use and worsening glycemic control in patients with preexisting diabetes. Methods Data were recorded from electronic medical records of veteran patients aged 18 to 80 with COPD and T2DM on at least 2 oral antiglycemic medications from January 1, 2000, to December 31, 2017, at the Veterans Affairs (VA) North Texas Health Care System (VANTHCS). The primary outcome was the rate of A1c progression >10% at 12 months and 5 years. Results This study included 127 (64 in the ICS group and 63 in the non-ICS group) patients; baseline characteristics between groups were similar with the exception of age and tobacco use. No statistically significant difference was found between groups with regard to the primary outcome. More patients in the non-ICS group had antiglycemic medications initiated at 12 months ( P = .009) and 5 years ( P = .003) compared to the ICS group. Conclusion Inhaled corticosteroids did not negatively impact glycemic control among veterans with comorbid COPD and T2DM.

scholarly journals Muscle strength, an independent determinant of glycemic control in older adults with long-standing type 2 diabetes: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bo Kyung Koo ◽  
Seoil Moon ◽  
Min Kyong Moon
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Older Adults ◽  
Glycemic Control ◽  
Muscle Mass ◽  
Older Patients ◽  
Primary Outcome ◽  
Muscle Quality

Abstract Background Although the proportion of older patients with type 2 diabetes mellitus (T2DM) has increased, few studies have reported the factors affecting glucose levels in older patients with long-standing T2DM. This study assessed the determinants of glycemic control in older adults with T2DM of a duration of ≥10 years, including muscle mass, muscle quality, and β-cell function. Methods This was a prospective study of older patients aged ≥60 years with a T2DM duration of ≥10 years. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index, handgrip strength (HGS), and body composition through bioelectrical impedance analysis were assessed. The primary outcome was a composite of: (i) increment of glycated hemoglobin (HbA1c) from the baseline ≥0.6% and (ii) HbA1c ≥ 9% at any time point during the follow-up period. To find the predicting determinants of the outcome, we performed the Cox proportional hazard analysis. Results Among 100 patients (mean age, 64.0 ± 8.6 years; median duration of diabetes, 20 [interquartile range (IQR), 17–23] years; median HbA1c at baseline, 7.1 [IQR, 6.7–7.4] %), the primary outcome was observed in 40 (40.0%) patients during 4.0 (IQR 2.3–5.0) years of follow-up. A Cox proportional hazards model adjusted for age, sex, baseline HbA1c, obesity, duration of DM and anti-diabetic medication at baseline showed that low HGS and insulin resistance at the baseline were independent determinants of the primary outcome (hazard ratio [HR] = 2.23 [95% confidence interval (CI), 1.06–4.72] and 2.39 [95% CI, 1.18–4.83], respectively). Sex stratification confirmed that HGS and muscle mass were independent determinants of the primary outcome only in women (HR per quartile, 0.58 [95% CI, 0.37–0.93] and 0.46 [95% CI, 0.25–0.85], respectively). `. Conclusions Low HGS and insulin resistance were independent risk factors for aggravated glycemic control among older patients with long standing T2DM.

Sign in / Sign up

Export Citation Format

Share Document