Share This Article:

Comparison on Efficacy and Safety of Three Inpatient Insulin Regimens for Management of Non-Critical Patients with Type 2 Diabetes

Abstract Full-Text HTML Download Download as PDF (Size:303KB) PP. 556-565
DOI: 10.4236/pp.2013.47080    3,109 Downloads   4,785 Views   Citations

ABSTRACT

Background: Hyperglycemia in hospitalized patients is associated with poor clinical outcomes. Scheduled Subcutaneous Insulin therapy has been recommended for better glycemic control. Aims: To compare efficacy and safety of traditional sliding scale insulin (SSI) versus modified 70/30 insulin versus basal plus supplemental scale (SS) insulin regimens for glycemic control of inpatients with diabetes. Methods: In a prospective trial, 62 patients with diabetes were randomized to receive either hospital SSI (N = 22), or twice daily 70/30 insulin plus supplemental lunchtime insulin for BG ≥ 150 mg/dL (N = 21) or once every night glargine plus prandial glulisine for BG ≥ 150 mg/dL (N = 19). 70/30 insulin and glargine were started respectively at 0.4 and 0.2 U/kg/day for BG ≤ 200 mg/dL or 0.5 and 0.3 U/kg/day for BG above 200 mg/dL. Results: Starting at BG level of 204 ± 68, 200 ± 50 and 241 ± 94 mg/dL in SSI, 70/30 insulin and glargine/glulisine groups respectively, (F(2,35.47) = 1.467, p = 0.244, Welch test), mean daily BG after first day of hospitalization was statistically significant (F(2,35.58) = 7.043, p = 0.003, Welch test) lower in 70/30 insulin group (171 ± 38 mg/dL) compared to (218 ± 71 mg/dL) in SSI group (p = 0.026) and (225 ± 65 mg/dL) in glargine/glulisine group (p = 0.01). Conclusions: With poorly educated nursing staff, basal plus SS insulin failed to provide adequate glycemic control. However, tailored 70/30 insulin regimen resulted in statistically significant glycemic control compared to traditional SSI.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

E. Said, S. Farid, N. Sabry and M. Fawzi, "Comparison on Efficacy and Safety of Three Inpatient Insulin Regimens for Management of Non-Critical Patients with Type 2 Diabetes," Pharmacology & Pharmacy, Vol. 4 No. 7, 2013, pp. 556-565. doi: 10.4236/pp.2013.47080.

References

[1] W. H. Herman, M. A. Ali, R. E. Aubert, et al., “Diabetes Mellitus in Egypt: Risk Factors and Prevalence,” Diabetic Medicine, Vol. 12, No. 12, 1995, pp. 1126-1131.
http://dx.doi.org/10.1111/j.1464-5491.1995.tb00432.x
[2] J. Shaw, R. Sicree and P. Zimmet, “Global Estimates of the Prevalence of Diabetes for 2010 and 2030,” Diabetes Research Clinical Practice, Vol. 87, No. 1, 2010, pp. 4-14. http://dx.doi.org/10.1016/j.diabres.2009.10.007
[3] G. W. Guy, A. V. W. Nunn, L. E. Thomas and J. D. Bell, “Obesity, Diabetes and Longevity in the Gulf: Is there a Gulf Metabolic Syndrome?” International Journal of Diabetes Mellitus, Vol. 1, No. 1, 2009, pp. 43-54.
http://dx.doi.org/10.1016/j.ijdm.2009.05.001
[4] H. J. Jiang, D. Stryer, B. Friedman and R. Andrews, “Multiple Hospitalizations for Patients with Diabetes,” Diabetes Care, Vol. 26, No. 5, 2003, pp. 1421-1426.
http://dx.doi.org/10.2337/diacare.26.5.1421
[5] G. E. Umpierrez, S. D. Isaacs, N. Bazargan, X. You, L. M. Thaler and A. E. Kitabchi, “Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes,” The Journal of Clinical Endocrinology & Metabolism, Vol. 87, No. 3, 2002, pp. 978-982. http://dx.doi.org/10.1210/jc.87.3.978
[6] J. L. Schnipper, E. E. Barsky, S. Shaykevich, G. Fitzmaurice and M. L. Pendergrass, “Inpatient Management of Diabetes and Hyperglycemia among General Medicine Patients at a Large Teaching Hospital,” Journal of Hospital Medicine, Vol. 1, No. 3, 2006, pp. 145-150.
http://dx.doi.org/10.1002/jhm.96
[7] S. Clement, S. S. Braithwaite, M. F. Magee, A. Ahmann, E. P. Smith, R. G. Schafer and I. B. Hirsch, “Management of Diabetes and Hyperglycemia in Hospitals,” Diabetes Care, Vol. 27, No. 2, 2004, pp. 553-597.
http://dx.doi.org/10.2337/diacare.27.2.553
[8] A. D. Association, “Standards of Medical Care in Diabetes—2013. (Position Statement),” Diabetes Care, Vol. 36, No. 1, 2013, pp. S11-S66.
http://dx.doi.org/10.2337/dc13-S011
[9] G. E. Umpierrez, R. Hellman, M. T. Korytkowski, M. Kosiborod, G. A. Maynard, V. M. Montori, J. J. Seley and G. Van den Berghe, “Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline,” The Journal of Clinical Endocrinology & Metabolism, Vol. 97, No. 1, 2012, pp. 16-38.
http://dx.doi.org/10.1210/jc.2011-2098
[10] T. Becker, A. Moldoveanu, T. Cukierman and H. C. Gerstein, “Clinical Outcomes Associated with the Use of Subcutaneous Insulin-by-Glucose Sliding Scales to Manage Hyperglycemia in Hospitalized Patients with Pneumonia,” Diabetes Research Clinical Practice, Vol. 78, No. 3, 2007, pp. 392-397.
http://dx.doi.org/10.1016/j.diabres.2007.05.003
[11] M. F. Magee and S. Clement, “Subcutaneous Insulin Therapy in the Hospital Setting: Issues, Concerns, and Implementation,” Endocrine Practice, Vol. 10, No. 1, 2004, pp. 81-88. http://dx.doi.org/10.4158/EP.10.S2.81
[12] B. Boehm, P. Home, C. Behrend, N. Kamp and A. Lindholm, “Premixed Insulin Aspart 30 vs. Premixed Human Insulin 30/70 Twice Daily: A Randomized Trial in Type 1 and Type 2 Diabetic Patients,” Diabetic Medicine, Vol. 19, No. 5, 2002, pp. 393-399.
http://dx.doi.org/10.1046/j.1464-5491.2002.00733.x
[13] S. E. Inzucchi, “Management of Hyperglycemia in the Hospital Setting,” The New England Journal of Medicine, Vol. 355, No. 18, 2006, pp. 1903-1911.
http://dx.doi.org/10.1056/NEJMcp060094
[14] G. E. Umpierrez, D. Smiley, A. Zisman, L. M. Prieto, A. Palacio, M. Ceron, A. Puig and R. Mejia, “Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients with Type 2 Diabetes (RABBIT 2 trial),” Diabetes Care, Vol. 30, No. 9, 2007, pp. 2181-2186. http://dx.doi.org/10.2337/dc07-0295
[15] G. E. Umpierrez, D. Smiley, S. Jacobs, L. Peng, A. Temponi, P. Mulligan, D. Umpierrez, C. Newton, D. Olson and M. Rizzo, “Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Ptients with Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery),” Diabetes care, Vol. 34, No. 2, 2011, pp. 256-261. http://dx.doi.org/10.2337/dc10-1407
[16] G. Maynard, D. H. Wesorick, C. O’Malley and S. E. Inzucchi, “Subcutaneous Insulin Order Sets and Protocols: Effective Design and Implementation Strategies,” Journal of Hospital Medicine, Vol. 3, No. 5, 2008, pp. 29-41.
[17] G. E. Umpierrez, et al., “Comparison of Inpatient Insulin Regimens with Detemir plus Aspart versus Neutral Protamine Hagedorn plus Regular in Medical Patients with Type 2 Diabetes,” The Journal of Clinical Endocrinology & Metabolism, Vol. 94, No. 2, 2009, pp. 564-569.
http://dx.doi.org/10.1210/jc.2008-1441
[18] S. J. Finney, C. Zekveld, A. Elia and T. W. Evans, “Glucose Control and Mortality in Critically Ill Patients,” The Journal of the American Medical Association, Vol. 290, No. 15, 2003, pp. 2041-2047.
http://dx.doi.org/10.1001/jama.290.15.2041
[19] I. Stranders, M. Diamant, R. E. van Gelder, H. J. Spruijt, J. W. R. Twisk, R. J. Heine and F. C. Visser, “Admission Blood Glucose Level as Risk Indicator of Death after Myocardial Infarction in Patients with and without Diabetes Mellitus,” Archives of Internal Medicine Vol. 164, No. 9, 2004, pp. 982-988.
http://dx.doi.org/10.1001/archinte.164.9.982
[20] J. M. Schoeffler, D. A. K. Rice and D. G Gresham, “70/30 Insulin Algorithm versus Sliding Scale Insulin,” The Annals of Pharmacotherapy, Vol. 39, No. 10, 2005, pp. 1606-1609.
http://dx.doi.org/10.1345/aph.1E661
[21] A. Liebl, R. Prager, M. Kaiser, K. Binz and B. Gallwitz, “Biphasic Insulin Aspart 30 (BIAsp30), Insulin Detemir (IDet) and Insulin Aspart (IAsp) Allow Patients with Type 2 Diabetes to Reach A1C Target: The Prefer study,” Diabetes, Vol. 55, Suppl. 1, 2006, p. 123.
[22] D. R. Owens, P. A. Coates, S. D. Luzio, J. P. Tinbergen and R. Kurzhals, “Pharmacokinetics of 125I-Labeled Insulin Glargine (HOE 901) in Healthy Men: Comparison with NPH Insulin and the Influence of Different Subcutaneous Injection Sites,” Diabetes Care, Vol. 23, No. 6, 2000, pp. 813-819.
http://dx.doi.org/10.2337/diacare.23.6.813
[23] R. Ligthelm, U. Mouritzen, H. Lynggaard, et al., “Biphasic Insulin Aspart Given Thrice Daily Is as Efficacious as a Basal-Bolus Insulin Regimen with Four Daily Injections: A Randomised Open-Label Parallel Group Four Months Comparison in Patients with Type 2 Diabetes,” Experimental and Clinical Endocrinology & Diabetes, Vol. 114, No. 9, 2006, pp. 511-519.
http://dx.doi.org/10.1055/s-2006-924424
[24] M. Clements, J. Tits, B. Kinsley, J. Rastam, H. Friberg and R. Ligthelm, “Improved Glycaemic Control of ThriceDaily Biphasic Insulin Aspart Compared with Twice-Daily Biphasic Human Insulin; a Randomized, Open-Label Trial in Patients with Type 1 or Type 2 Diabetes,” Diabetes, Obesity and Metabolism, Vol. 10, No. 3, 2008, pp. 229-237.
http://dx.doi.org/10.1111/j.1463-1326.2006.00687.x
[25] G. Shanmugasundar, A. Bhansali, R. Walia, P. Dutta and V. Upreti, “Comparison of Thrice Daily Biphasic Human Insulin (30/70) versus Basal Detemir & Bolus Aspart in Patients with Poorly Controlled Type 2 Diabetes Mellitus—A Pilot Study,” Indian Journal of Medical Research, Vol. 135, No. 1, 2012, pp. 78-83.
http://dx.doi.org/10.4103/0971-5916.93428
[26] R. R. Holman, A. J. Farmer, M. J. Davies, J. C. Levy, J. L. Darbyshire, J. F. Keenan and S. K. Paul, “Three-Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes,” The New England Journal of Medicine, Vol. 361, No. 18, 2009, pp. 1736-1747.
http://dx.doi.org/10.1056/NEJMoa0905479
[27] S. Yamada, M. Watanabe, O. Funae, Y. Atsumi, R. Suzuki, K. Yajima, Y. Nakamura, T. Kawai, Y. Oikawa and A. Shimada, “Effect of Combination Therapy of a Rapid-Acting Insulin Secretagogue (Glinide) with Premixed Insulin in Type 2 Diabetes Mellitus,” Internal Medicine, Vol. 46, No. 23, 2007, pp. 1893-1897.
http://dx.doi.org/10.2169/internalmedicine.46.0415
[28] L. M. Dickerson, X. Ye, J. L. Sack and W. J. Hueston, “Glycemic Control in Medical Inpatients with Type 2 Diabetes Mellitus Receiving Sliding Scale Insulin Regimens versus Routine Diabetes Medications: A Multicenter Randomized Controlled Trial,” Annals of Family Medicine, Vol. 1, No. 1, 2003, pp. 29-35.
http://dx.doi.org/10.1370/afm.2
[29] W. D. Smith, A. G. Winterstein, T. Johns, E. Rosenberg and B. C. Sauer, “Causes of Hyperglycemia and Hypoglycemia in Adult Inpatients,” American Journal of Health-System Pharmacy, Vol. 62, No. 7, 2005, pp. 714-719.
[30] G. E. Umpierrez, A. Palacio and D. Smiley, “Sliding Scale Insulin Use: Myth or Insanity?” The American Journal of Medicine, Vol. 120, No. 7, 2007, pp. 563-567.
http://dx.doi.org/10.1016/j.amjmed.2006.05.070
[31] I. B. Hirsch, “Sliding Scale Insulin—Time to Stop Sliding,” The Journal of the American Medical Association, Vol. 301, No. 2, 2009, pp. 213-214.
http://dx.doi.org/10.1001/jama.2008.943
[32] L. A. Browning and P. Dumo, “Sliding-Scale Insulin: An Antiquated Approach to Glycemic Control in Hospitalized Patients,” American Journal of Health-System Pharmacy, Vol. 61, No. 15, 2004, pp. 1611-1614.
[33] L. H. Aiken, S. P. Clarke, D. M. Sloane, J. A. Sochalski, R. Busse, H. Clarke, P. Giovannetti, J. Hunt, A. M. Rafferty and J. Shamian, “Nurses’ Reports on Hospital Care in Five Countries,” Health affairs, Vol. 20, No. 3, 2001, pp. 43-53. http://dx.doi.org/10.1377/hlthaff.20.3.43
[34] A. E. Tourangeau, D. M. Doran, L. M. Hall, L. O’Brien Pallas, D. Pringle, J. V. Tu and L. A. Cranley, “Impact of Hospital Nursing Care on 30 Day Mortality for Acute Medical Patients,” Journal of Advanced Nursing, Vol. 57, No. 1, 2007, pp. 32-44.
http://dx.doi.org/10.1111/j.1365-2648.2006.04084.x
[35] C. R. Friese, E. T. Lake, L. H. Aiken, J. H. Silber, J. Sochalski, “Hospital Nurse Practice Environments and Outcomes for Surgical Oncology Patients,” Health Services Research, Vol. 43, No. 4, 2008, pp. 1145-1163.
http://dx.doi.org/10.1111/j.1475-6773.2007.00825.x
[36] T. A. Lang, M. Hodge, V. Olson, P. S. Romano and R. L. Kravitz, “Nurse-Patient Ratios: A Systematic Review on the Effects of Nurse Staffing on Patient, Nurse Employee, and Hospital Outcomes,” The Journal of Nursing Administration, Vol. 34, No. 7-8, 2004, pp. 326-337.
http://dx.doi.org/10.1097/00005110-200407000-00005
[37] M. Manojlovich and B. DeCicco, “Healthy Work Environments, Nurse-Physician Communication, and Patients’ Outcomes,” American Journal of Critical Care, Vol. 16, No. 6, 2007, pp. 536-543.
[38] L. M. Hall, D. Doran, G. R. Baker, G. H. Pink, S. Sidani, L. O’Brien-Pallas and G. J. Donner, “Nurse Staffing Models as Predictors of Patient Outcomes,” Medical Care, Vol. 41, No. 9, 2003, pp. 1096-1109.
http://dx.doi.org/10.1097/01.MLR.0000084180.07121.2B
[39] World Medical Association, “Declaration of Helsinki,” 2013.
http://www.wma.net/en/20activities/10ethics/10helsinki/

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.