Sliding-scale insulin: An antiquated approach to glycemic control in hospitalized patients

Browning, Linda A; Dumo, Peter

doi:10.1093/ajhp/61.15.1611

Cited by 50 publications

(40 citation statements)

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“…Data from our group and others [9,10,14] have shown, that the use of SSI resulted in significantly higher intra-hospital glycemia. SSI is usually practiced by housestaff physicians and generally transmitted as a tradition among trainees [11,12,14].…”

supporting

confidence: 52%

Predictors of sliding scale insulin use by housestaff physicians in the management of hospitalized patients with diabetes mellitus

McFarlane

Gliwa

Bubb³

et al. 2006

Therapy

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Objective: To identify predictive factors for the use of sliding scale insulin (SSI) by the housestaff physicians for in-hospital management of diabetes mellitus (DM). Design: Prospective cohort study. Materials & methods: A total of 215 consecutive patients admitted to the medical or surgical wards of two urban University-affiliated hospitals, with DM as a primary or secondary diagnosis, were prospectively followed to discharge. Demographic, laboratory and clinical data were obtained from in-hospital records. A survey was administered to the primary housestaff physicians regarding the potential reasons for prescribing SSI versus proactive antihyperglycemic therapy (standing insulin dose and/or oral antidiabetic agents). Results: SSI was prescribed for 71.2% of the patients and the lowest blood glucose (BG) at which insulin was given was recorded at 150-199 mg/dl (13.2% [of patients]), 200-249 mg/dl (81.1%) and 250-299 mg/dl (6.7%). Factors that predicted the use of SSI by housestaff physicians included the admission service, surgery versus medicine (odds ration [OR]: 6.0, 95% confidence interval: 5.5-23.3; p = 0.01), concern regarding wide swings of BG (OR: 5.56 [1.8-16.8]; p < 0.01), using the SSI results to estimate the standing dose of insulin ]; p < 0.01) and high BG on admission (OR: 3.92 [1.3-12.3]; p < 0.02). Conclusion: SSI is commonly prescribed for hospitalized patients with DM. It is more likely to be prescribed on the surgical wards compared with medical service. Perception among house staff regarding the wide swings of BG and the perception of the utility of the SSI to calculate standing-dose insulin were significant predictors for its use. Given the previous reports indicating higher in-hospital BG with the use of SSI, which leads to several complications, increased understanding of the reasons behind the use of SSI by house staff would help develop educational programs aimed at changing this practice in favor of more physiologic insulin regimens.

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supporting

confidence: 52%

Predictors of sliding scale insulin use by housestaff physicians in the management of hospitalized patients with diabetes mellitus

McFarlane

Gliwa

Bubb³

et al. 2006

Therapy

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“…Sliding-scale insulin is the most commonly used regimen to control inpatients' hyperglycemia 1,[12][13][14] . However, it is difficult to normalize blood glucose using this regimen 9,15 , because it is reactive to hyperglycemia rather than being preventive and it does not provide basal insulin or pre-meal bolus insulin.…”

Section: Discussionmentioning

confidence: 99%

In-hospital treatment of hyperglycemia: effects of intensified subcutaneous insulin treatment

Elinav

Wolf

Szalat

et al. 2007

Current Medical Research and Opinion

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“…2,4 Scheduled basal, nutritional, and correctional insulin components are preferred for treatment, as this regimen closely mimics normal insulin physiology as opposed to the widely used sliding scale insulin (SSI) method, which is a reactive approach for the treatment of hyperglycemia. 5 The efficacy of a basal-bolus dosing regimen has been reported previously in various studies. 6-10 Schnipper et al conducted a before and after trial using a basal-bolus subcutaneous insulin protocol, which was included in the admission order set.…”

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confidence: 83%

Pilot and Revision of a Basal-Bolus Dosing Guideline for the Management of Hyperglycemia in Noncritically Ill Adult Patients

Fahim

Davanos

Muzykovsky

et al. 2014

Journal of Pharmacy Practice

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The use of basal-bolus insulin (BBI) regimens for the treatment of inpatient hyperglycemia has become standard of care. The purpose of this study was to develop and evaluate a newly piloted dosing guideline and utilize the results to adjust it prior to its implementation hospital-wide. This was an institutional review board approved, prospective, and multiphase study. An interdisciplinary team was developed and created a dosing guideline, which was followed by a 3-month, single-unit pilot of the guideline in noncritically ill adult patients. The resulting data were used to revise the guideline. Forty-three patients were included. There was a significant decrease in median blood glucose (BG) with use of the guideline (219 mg/dL [162-281] vs 190 mg/dL [136-246], P < .05) in patients not utilizing it. There was also a significant increase in the number of values within the target range of 70 to 180 mg/dL (30.2% vs 41.4%, P < .05). Moreover, there was comparable hypoglycemia before and after the intervention (1.6% vs 2.4%, P = .51). Based on these results, the dosing factor used for the total daily dose of insulin was increased in certain populations. Use of a BBI dosing guideline is safe and effective in decreasing BG values in noncritically ill patients at our institution.

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Sliding-scale insulin: An antiquated approach to glycemic control in hospitalized patients

Cited by 50 publications

References 0 publications

Predictors of sliding scale insulin use by housestaff physicians in the management of hospitalized patients with diabetes mellitus

Predictors of sliding scale insulin use by housestaff physicians in the management of hospitalized patients with diabetes mellitus

In-hospital treatment of hyperglycemia: effects of intensified subcutaneous insulin treatment

Pilot and Revision of a Basal-Bolus Dosing Guideline for the Management of Hyperglycemia in Noncritically Ill Adult Patients

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