Outcomes of "Real-World" Insulin Strategies in the Management of Hospital Hyperglycemia.
J Endocr Soc
; 5(8): bvab101, 2021 Aug 01.
Article
en En
| MEDLINE
| ID: mdl-34235360
ABSTRACT
CONTEXT Guidelines recommend scheduled long-acting basal and short-acting bolus insulin several times daily to manage inpatient hyperglycemia. In the "real world," insulin therapy is complicated, with limited data on the comparative effectiveness of different insulin strategies. OBJECTIVE:
This work aimed to evaluate the association of different insulin strategies with glucose control and hospital outcomes after adjustment for patient and physician factors that influence choice of therapy.METHODS:
This retrospective, observational study took place at an academic hospital. Participants included noncritically ill hospitalized medical/surgical patients (nâ =â 4558) receiving subcutaneous insulin for 75% or longer during admission. Insulin therapy was grouped into 3 strategies within the first 48 hours basal bolus (BB scheduled long and short/rapid nâ =â 2358), sliding scale (SS short/rapid acting nâ =â 1855), or basal only (BO long only nâ =â 345). Main outcome measures included glucose control hypoglycemic days, hyperglycemic days, euglycemic days, mean glucose; and hospitalization in-hospital mortality, length of stay (LOS), and readmissions.RESULTS:
Initial therapy with BB was associated with more hypoglycemic (2.40; CI, 2.04 to 2.82) (Pâ <â .001) and fewer euglycemic days (0.90; CI, 0.85 to 0.97) (Pâ =â .003) than SS, whereas BO was associated with fewer hyperglycemic days (0.70; CI, 0.62 to 0.79) (Pâ <â .001), lower mean glucose (-18.03; CI, -22.46 to -12.61) (Pâ <â .001), and more euglycemic days (1.22; CI, 1.09 to 1.37) (Pâ <â .001) compared to SS. No difference in mortality, LOS, and readmissions was found. However, decreased LOS was observed in the BB subgroup with a medical diagnostic related group (0.93; CI, 0.89 to 0.97) (Pâ <â .001).CONCLUSION:
BO had a more favorable hyperglycemia profile than SS. BB, on the other hand, showed worse glycemic control as compared to SS. In the real-world hospital, BO may be a simpler and more effective insulin strategy.
Texto completo:
1
Banco de datos:
MEDLINE
Tipo de estudio:
Guideline
/
Observational_studies
Idioma:
En
Revista:
J Endocr Soc
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos