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 IJCM  Vol.9 No.4 , April 2018
Clinical Outcomes Associated with Use of Subcutaneous Sliding Scale Insulin Compared to Other Insulin Regimens in Hospitalized Patients
Abstract: Background: Hyperglycemia in hospitalized patients is managed through one of the following approaches: sliding scale insulin (SSI) alone; SSI plus long-acting insulin and basal-bolus insulin (BBI). The optimal insulin treatment regimen is still debated. Objectives: To evaluate the clinical outcomes associated with the use of SSI compared to other regimens. Setting: The general medical wards in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: Medical charts for adult patients admitted between October 2014-December 2015 with type 2 diabetes or uncontrolled hyperglycemia with insulin treatment were reviewed. Data from capillary blood glucose were measured daily for the first 5 days of hospitalization and recorded. Demographics and blood glucose levels were compared by group using one-way ANOVA or Chi-square test. The number of hyperglycemic/hypoglycemic episodes was analyzed using the Kruskal-Wallis test. Results: A total of 240 patients were included. The three insulin regimen groups were not statistically different in terms of the number of days with episodes of hyper- or hypoglycemia (p > 0.05). However, a significantly bigger change from baseline (improvement) in random blood glucose (RBG) levels was observed in BBI and SSI plus glargine patients compared to SSI (p = 0.014). Conclusion: Our study showed no significant difference in the number of days with episodes of hyper- or hypoglycemia for SSI vs. other insulin regimens. However, SSI patients had less improvement in their RBG levels compared to other insulin regimen groups. Further studies with a larger sample size are needed to confirm these findings.
Cite this paper: Alfehaid, L. , Alotaibi, A. , Alanazi, A. , Bustami, R. and Melik, R. (2018) Clinical Outcomes Associated with Use of Subcutaneous Sliding Scale Insulin Compared to Other Insulin Regimens in Hospitalized Patients. International Journal of Clinical Medicine, 9, 260-269. doi: 10.4236/ijcm.2018.94023.
References

[1]   Danaei, G., Finucane, M., Lu, Y., Singh, G., et al. (2011) National, Regional, and Global Trends in Fasting Plasma Glucose and Diabetes Prevalence since 1980: Systematic Analysis of Health Examination Surveys and Epidemiological Studies with 370 Country-Years and 2.7 Million Participants. The Lancet, 378, 31-40.
https://doi.org/10.1016/S0140-6736(11)60679-X

[2]   Aljabri, K., Bokhari, S. and Alqurashi, K. (2011) Prevalence of Diabetes Mellitus in a Saudi Community. Annals of Saudi Medicine, 31, 19-23.
https://doi.org/10.4103/0256-4947.75773

[3]   Diabetes Successes and Opportunities for Population-Based Prevention and Control at a Glance. CDC National Center for Chronic Disease Prevention and Health Promotion. 2011.
https://www.cdc.gov/chronicdisease/resources/publications/
aag/diabetes.htm


[4]   Leite, S., Locatelli, S., Niece, S., Oliveira, A., Tockus, D. and Tosin, T. (2010) Impact of Hyperglycemia on Morbidity and Mortality, Length of Hospitalization and Rates of Re-Hospitalization in a General Hospital Setting in Brazil. Diabetology & Metabolic Syndrome, 2, 49.
https://doi.org/10.1186/1758-5996-2-49

[5]   Kim, S., Kim, B., Ha, E., Moon, M. and Park, S. (2010) Effect of Hyperglycemia on Mortality Rates in Critically Ill Children. Korean Journal of Pediatrics, 53, 323-328.
https://doi.org/10.3345/kjp.2010.53.3.323

[6]   Falciglia, M. (2010) Hyperglycemia-Related Mortality in Critically Ill Patients Varies with Admission Diagnosis. Critical Care Medicine, 38, 1388-1389.
https://doi.org/10.1097/CCM.0b013e3181d8be4b

[7]   Clement, S., Braithwaite, S., Magee, M., et al. (2004) Management of Diabetes and Hyperglycemia in Hospitals. Diabetes Care, 27, 553-591.
https://doi.org/10.2337/diacare.27.2.553

[8]   Garber, A.J., Moghissi, E.S., Bransome, E.D., et al. (2004) American College of Endocrinology position statement on Inpatient Diabetes and Metabolic Control. Endocrine Practice, 10, 4-9.
https://doi.org/10.4158/EP.10.S2.4

[9]   Joslin, E. (1919) A Diabetic Manual for the Mutual Use of Doctor and Patient. 2nd Edition, Lea &Febiger, Philadelphia and New York.

[10]   Umpierrez, G., Smiley, D., Zisman, A., et al. (2007) Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients with Type 2 Diabetes (RABBIT 2 Trial). Diabetes Care, 30, 2181-2186.
https://doi.org/10.2337/dc07-0295

[11]   Umpierrez, G.E., Smiley, D., Jacobs, S., et al. (2011) Randomized Study of Basal-Bolus Insulin Therapy in The Inpatient Management of Patients with Type Two Diabetes Undergoing General Surgery (RABBIT 2 Surgery). Diabetes Care, 34, 256-261.
https://doi.org/10.2337/dc10-1407

[12]   Michota, F. (2007) What Are the Disadvantages of Sliding-Scale Insulin? The Journal of Hospital Medicine, 2, 20-22.
https://doi.org/10.1002/jhm.183

[13]   Umpierrez, G.E., Palacio, A. and Smiley, D. (2007) Sliding Scale Insulin Use: Myth or Insanity? The American Journal of Medicine, 120, 563-567.
https://doi.org/10.1016/j.amjmed.2006.05.070

[14]   Browning, L.A. and Dumo, P. (2004) Sliding-Scale Insulin: An Antiquated Approach to Glycemic Control in Hospitalized Patients. American Journal of Health-System Pharmacy, 61, 1611-1614.

[15]   Hirsch, I.B. (2009) Sliding Scale Insulin-Time to Stop Sliding. JAMA, 301, 213-214.

[16]   Patel, G.W., Roderman, N., Lee, K.A., et al. (2009) Sliding Scale versus Tight Glycemic Control in the Non-Critically Ill at a Community Hospital. Annals of Pharmacotherapy, 43, 1774-1780.
https://doi.org/10.1345/aph.1M331

[17]   Dharmarajan, M.D., Zambrano, A., et al. (2016) Sliding Scale Insulin vs Basal-Bolus Insulin Therapy in Long-Term Care: A 21-Day Randomized Controlled Trial Comparing Efficacy, Safety and Feasibility. JAMDA, 17, 206-213.

[18]   Valgardson, J., Merino, M., Redgrave, J., Hudson, J. and Hudson, M. (2015) Effectiveness of Inpatient Insulin Order Sets Using Human Insulins in Noncritically Ill Patients in a Rural Hospital. Endocrine Practice, 21, 794-806.
https://doi.org/10.4158/EP14153.OR

[19]   Akhtar, S.T., Mahmood, K., Naqvi, I.H. and Vaswani, A.S. (2014) Inpatient Management of Type2 Diabetes Mellitus: Does Choice of Insulin Regimen Really Matter? Pakistan Journal of Medical Sciences, 30, 895-898.

[20]   Gearhart, J.G., Duncan, J.L., Replogic, W.H., Forbes, R.C. and Walley, E.J. (1994) Efficacy of Sliding-Scale Insulin Therapy: A Comparison with Prospective Regimens. The Family Practice Research Journal, 14, 313-322.

[21]   Roberts, G.W., Aguilar-Loza, N., Esterman, A., Burt, M.G. and Stranks, S.N. (2012) Basal-Bolus Insulin versus Sliding-Scale Insulin for Inpatient Glycaemic Control: A Clinical Practice Comparison. The Medical Journal of Australia, 196, 266-269.
https://doi.org/10.5694/mja11.10853

 
 
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