Glycemic Control and Sliding Scale Insulin Use in Medical Inpatients With Diabetes Mellitus

Queale, William S.; Seidler, Alexander J.; Brancati, Frederick L.

doi:10.1001/archinte.1997.00440260101014

Cited by 273 publications

(170 citation statements)

References 39 publications

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“…SSI simply reacts to hyperglycemia instead of preventing the occurrence of hyperglycemia and could lead to a higher glucose level variability, which might be associated with an inferior outcome. 77,78 Therefore, SSI alone is not recommended as inpatient glucose control. [79][80][81] Basal-bolus insulin (BBI) is more reliable for inpatient glucose control.…”

Section: Treatment/management Of Ptdmmentioning

confidence: 99%

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Fuji

Rovó

Ohashi

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients frequently develop glucose intolerance and post-transplant diabetes mellitus (PTDM). The clinical importance of PTDM and its detrimental impact on HSCT outcomes are underrecognized. After allo-HSCT, various mechanisms can contribute to the development of PTDM. Here we review information about hyperglycemia and PTDM after allo-HSCT as well as PTDM after solid organ transplantation and describe ways to manage hyperglycemia/PTDM after allogeneic HSCT. Taking into consideration a lack of well-established evidence in the field of allo-HSCT, more studies should be conducted in the future, which will require closer multidisciplinary collaboration between hematologists, endocrinologists and nutritionists.

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Section: Treatment/management Of Ptdmmentioning

confidence: 99%

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Fuji

Rovó

Ohashi

et al. 2016

Bone Marrow Transplant

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“…10,11 The use of correction insulin-the so-called sliding scale-without concurrent use of basal insulin in the hospital results in ineffective control of hyperglycemia. 12,13 In noncritically ill medical and surgical inpatients, the most efficacious insulin program to treat glucose levels above recommended targets consists of a combination of long-acting basal insulin and short-acting insulin with meals when the patient is eating, supplemented by correction doses for high glucose values. [14][15][16] Clinical inertia is defined as the failure to intensify therapy when needed.…”

Section: Introductionmentioning

confidence: 99%

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Coan

Schlinkert

Beck

et al. 2013

J Diabetes Sci Technol

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Objective:Our objective was to assess the application of insulin regimens in surgical postoperative patients with diabetes. Methods:A chart review was conducted of patients with diabetes who were hospitalized postoperatively between January 1 and April 30, 2011. Analysis was restricted to patients hospitalized for ≥3 days and excluded cases with an endocrinology consult. Insulin regimens were categorized as "basal plus short acting," "short acting only," or "none," and the pattern of use was evaluated by hyperglycemia severity according to tertiles of both mean glucose and the number of glucose measurements >180 mg/dl. Results:Among cases selected for analysis (n = 119), examination of changes in insulin use based on tertiles of mean glucose showed that use of basal plus short-acting insulin increased from 10% in the lowest tertile (mean glucose, 120 mg/dl) to 18% in the highest tertile (mean glucose, 198 mg/dl; p < .01); however, 70% of patients in the highest tertile continued to receive short-acting insulin only, with 12% receiving no insulin. Intensification of insulin to a basal plus short-acting regimen was also seen when changes were evaluated by the number of measurements >180 mg/dl (p < .01), but 70% and 12% of patients in the highest tertile still remained only on short-acting insulin or received no insulin, respectively. Conclusions:Use of basal plus short-acting insulin therapy increased with worsening hyperglycemia, but many cases did not have therapy intensified to the recommended insulin regimen-evidence of clinical inertia. Strategies should be devised to overcome inpatient clinical inertia in the treatment of postoperative patients with diabetes.

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“…However, evidence supporting the effectiveness of SSI alone is lacking, and it is not recommended by the American Diabetes Association. 13 Queale et al 14 showed that SSI regimens when used alone were associated with suboptimal glycemic control and a 3-fold higher risk of hyperglycemic episodes. 1 Two retrospective studies have also demonstrated that SSI is less effective and widely variable in comparison with proactive preventative therapy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of glycemic control following discontinuation of an intensive insulin protocol

Czosnowski¹,

Swanson²,

Lobo³

et al. 2009

Journal of Hospital Medicine

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BACKGROUND:Intensive insulin protocols (IIPs) have been demonstrated to reduce morbidity and mortality in critically ill patients. Currently, there are no published studies evaluating glycemic control after discontinuation of an IIP.OBJECTIVE:The purpose of this study was to compare blood glucose (BG) control during an IIP and for 5 days following its discontinuation (follow‐up period).METHODS:The study was a retrospective review of intensive care unit patients who received an IIP for ≥24 hours. Data were collected during the last 12 hours of the IIP and subsequent follow‐up period.RESULTS:For all 65 included patients, the mean ± standard deviation for BG on the IIP was 123 ± 26 mg/dL versus 168 ± 50 mg/dL following discontinuation of the IIP (P < 0.001). The median (interquartile range) insulin that was administered decreased from 40 (22–65) units on the IIP to 8 (0–18) units after the IIP was stopped (P < 0.001). The mean daily BG during the follow‐up period was significantly higher than that during the IIP (P < 0.001). Additionally, an insulin requirement of >20 units during the last 12 hours of the IIP was identified as a risk factor for poor glycemic control during the follow‐up period (odds ratio: 4.62; 95% confidence interval: 1.17–18.17).CONCLUSIONS:This study demonstrates a significant increase in BG following discontinuation of an IIP. Higher insulin requirements during the last 12 hours of an IIP were identified as an independent risk factor for poor glycemic control following the IIP. A standardized insulin transition protocol may help better control BG after discontinuation of an IIP. Journal of Hospital Medicine 2009;4:28–34. © 2009 Society of Hospital Medicine.

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Glycemic Control and Sliding Scale Insulin Use in Medical Inpatients With Diabetes Mellitus

Cited by 273 publications

References 39 publications

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Evaluation of glycemic control following discontinuation of an intensive insulin protocol

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