Evaluation of Protocol Guided Scheduled Basal-Nutritional-Correction Insulin over Standard Care for Vascular Surgery Patients

Harbin, Megan; Dossa, Anar; Drummond, Isla; Lemos, Jane de; Paty, Breay W.; Taylor, Bobby

doi:10.1016/j.jcjd.2014.07.022

Cited by 3 publications

(6 citation statements)

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“…The types of intervention varied, as well as the implementation strategies, and measures of improvement between studies (see Table S4). Although three studies [19] x Courtenay 2007 [17] x x Donihi 2006 [26] x x Dooley 2011 [28] x Donsa 2016 [27] x x Doyle 2014 [54] x x x x Ena 2009 [41] x x Gomez-Huelgas 2014 [55] x x Guerra 2010 [43] x x x Hamilton 2013 [18] x Harbin 2015 [36] x x Helmle 2017 [37] x x x x x x x Horton 2015 [44] x Kowiatek 2001 [29] x x x x Lehnbom 2009 [35] x x Mamillapalli 2012 [38] x Maynard 2009 [45] x x x McIver 2009 [30] x x x Mulla 2015 [39] x x x Newsom 2018 [15] x x x x Noschese 2008m [46] x x Rushmer 2008 [31] x x x Schnipper 2009 [47] x x x Schnipper 2010 [48] x Taylor 2012 [32] x Thompson 2009 [49] x x x Trujillo 2008 [50] x x Tully 2018 [33] x x x Vaidya 2012 [56] x Valgardson 2015 [52] x x Wesorick 2010 [34] x x Wexler 2010 [52] x Wong 2016 [40] x x Yeung 2018 [53] x x ª 2019 Diabetes UK used the UK's National Inpatient Diabetes Audit (NaDIA) methodology and data collection tool, the follow-up period, interventions, implementation and the data reported were varied, hence it was difficult to pool data or make meaningful comparisons [18,19,32]. The introduction of simple, small focused interventions led to an improvement in the completeness and accuracy of insulin prescribing, particularly when they involved 'hard stops' (such as pre-printi...…”

Section: Interventions To Improve Insulin Prescribing Accuracy and Comentioning

confidence: 99%

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

2019

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Aim To conduct a systematic review of literature to identify interventions that are effective in improving insulin prescribing for people with diabetes in the hospital setting. Methods Computerized bibliographic databases were searched for studies published in English that described the effectiveness of interventions to improve insulin prescribing within the hospital setting. Studies were eligible for inclusion if they reported data that compared insulin prescribing practice after an intervention or compared with a control group. Studies were not excluded on the basis of publication date, geographical location or risk of bias assessment. Results We identified 35 studies for inclusion in the review, including two cluster randomized controlled trials, two cohort studies, and 31 uncontrolled before–after studies. Studies reported a variety of interventions that aimed to increase insulin prescribing accuracy or completeness or decrease the use of discouraged subcutaneous sliding scale insulin regimens. Differences in definition of insulin prescribing error, terminology and common practice based on geographical location was evident, and quality issues with respect to study design and reporting somewhat limited the interpretation of conclusions. Conclusions Implementing strategies that are sensitive to local context and designed to increase adherence to insulin prescribing guidelines are associated with a reduction in prescribing errors. Future implementation should build on effective approaches including multifaceted interventions involving multiple stakeholders at various institutional levels. Future studies in insulin prescribing errors would benefit from the use of standardized approaches, terminology and outcome measures to enable greater comparison.

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Section: Interventions To Improve Insulin Prescribing Accuracy and Comentioning

confidence: 99%

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

2019

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“…Five studies were RCTs, 10-14 2 were observational, prospective studies with historical controls, 15,16 and 5 were retrospective studies. [17][18][19][20][21] Characteristics of the included studies are presented in Table 1, including number and mean age of patients, mean admission blood glucose, and mean HbA1C. All studies were done in a non-ICU setting.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…Six studies reported significantly more episodes of hypoglycemia in patients treated with basal-bolus therapy than in patients treated with sliding scale. 13,[15][16][17]21,22 Two retrospective studies reported significantly more episodes of hypoglycemia in SSItreated patients than in BBI-treated patients. 18,21 The remaining 4 studies found no significant difference in hypoglycemic episodes between the 2 treatment regimens.…”

Section: Hypoglycemiamentioning

confidence: 99%

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Efficacy of basal‐bolus insulin regimens in the inpatient management of non‐critically ill patients with type 2 diabetes: A systematic review and meta‐analysis

Christensen

Gotfredsen

Nørgaard

2017

Diabetes Metabolism Res

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Hyperglycemia during hospitalization is associated with increased rates of complications and longer hospital stays. Various insulin regimens are used in the inpatient diabetes management of non-critically ill patients. In this systematic review and meta-analysis, we aimed to assess the efficacy and safety of basal-bolus insulin therapy (BBI) by summarizing evidence from studies of BBI versus sliding scale insulin therapy (SSI) in the management of hospitalized non-critically ill type 2 diabetes patients. We searched MEDLINE, EMBASE, Scopus, and the Cochrane Library for studies comparing BBI therapy with SSI therapy in hospitalized non-critically ill patients with type 2 diabetes. Primary outcome was mean daily blood glucose (BG) during admission. Secondary outcomes were incidence of hypoglycemia and length of hospital stay. Results of included randomized controlled trials (RCT) were pooled and meta-analysed to provide estimates of the efficacy of BBI therapy. Five RCTs and seven observational studies were included in the review. Meta-analysis of RCTs showed significantly lower mean daily BG with BBI than SSI. Mean difference in daily BG between the two regimens ranged from 14 to 29 mg/dl. BBI therapy was associated with increased risk of mild hypoglycemia (BG ≤ 70 mg/dl, RR 5.75; 95% CI 2.79-11.83), (BG ≤ 60 mg/dl, RR 4.21; 95% CI 1.61-11.02) compared with SSI therapy. There was no difference in risk of severe hypoglycemia (BG ≤ 40 mg/dl) and no difference in mean length of stay. In conclusion, basal-bolus insulin in the inpatient diabetes management results in significantly lower mean daily BG than sliding scale insulin but is associated with increased risk of mild hypoglycemia.

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“…6 In studies investigating glycaemic control in the hospital setting, NPH insulin, insulin glargine U100 or insulin detemir were used as basal insulin. [7][8][9][10][11][12][13][14][15][16][17] To the best of our knowledge, novel basal insulin analogues, insulin glargine U300 or insulin degludec, have not yet been combined with automated basal-bolus insulin algorithms for the hospital setting. In previous studies GlucoTab, a mobile decision support (DSS) system for diabetes management that incorporates an automated basal-bolus algorithm, has proven to effectively and safely establish glycaemic control without increased risk of hypoglycaemia.…”

mentioning

confidence: 99%

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Aberer

Lichtenegger

Smajic

et al. 2018

Diabetes Obesity Metabolism

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Aims To investigate efficacy, safety and usability of the GlucoTab system for glycaemic management using insulin glargine U300 in non‐critically ill hospitalized patients with type 2 diabetes (T2D). Materials and Methods In this open, non‐controlled single‐arm pilot study, glycaemic control at the general ward of a tertiary care hospital was guided by a mobile decision support system (GlucoTab) for basal‐bolus insulin dosing using the novel basal insulin analogue insulin glargine U300 for the first time. Glycaemic control was surveilled with capillary glucose measurements and continuous glucose monitoring (CGM). The primary endpoint was efficacy of glycaemic management, defined as the percentage of blood glucose measurements within the target range of 3.9 to 7.8 mmol/L. Results A total of 30 patients with T2D (12 female; age, 67 ± 11 years; HbA1c, 70 ± 26 mmol/mol; BMI, 31.8 ± 5.6 kg/m 2 ; length of study, 8.5 ± 4.5 days) were included. In total, 894 capillary glucose values and 49 846 data points of CGM were available, of which 56.1% of all measured capillary glucose values and 54.3% of CGM values were within the target area (3.9‐7.8 mmol/L). Overall capillary mean glucose was 8.5 ± 1.2 and 8.4 ± 1.2 mmol/L assessed by CGM. Time within glucose target improved continuously during the course of treatment, while time within hypoglycaemia (<3.9 mmol/L) decreased substantially. The GlucoTab‐suggested total daily dose was accepted by staff in 97.3% of situations. Conclusions Treatment with GlucoTab using insulin glargine U300 in hospitalized patients with T2D is effective and safe.

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Evaluation of Protocol Guided Scheduled Basal-Nutritional-Correction Insulin over Standard Care for Vascular Surgery Patients

Cited by 3 publications

References 0 publications

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

Efficacy of basal‐bolus insulin regimens in the inpatient management of non‐critically ill patients with type 2 diabetes: A systematic review and meta‐analysis

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

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