A Retrospective Review of Sliding Scale vs. Basal/Bolus Insulin Protocols

Abstract

The purpose was to assess the differences between subcutaneous basal/bolus and sliding scale insulin protocols in patients admitted with type 2 diabetes on non-critical care units. Methods A retrospective review of electronic medical records was conducted on a convenience sample of inpatients in a central-city teaching hospital. Results The findings were that basal/bolus protocols achieved American Diabetes Association glycemic targets on fasting, mean, and discharge blood glucoses. Conclusions This study provided insight into glycemic control and interdisciplinary education needs at this hospital. Evidence revealed that basal/bolus insulin protocols can achieve glycemic targets.

The Effect of Basal Bolus Insulin Administration vs. Sliding Scale Insulin on Glycemic Control in Patients with Type 2 Diabetes Mellitus at a Community Hospital

“…In other words, there were no statistical differences between groups as related to age, gender and length of stay which was similar to other literature reviews of Rymaszewski &Breakwell, 2013, andUmpierrez et al, 2013. In comparison of the average blood glucose of the two groups, this study revealed that the SSI group showed a lower average blood glucose than the BBI group. This is contrary to several studies which demonstrated the clinical benefits (Fahim et al, 2015) and better glycemic control of using BBI over SSI (Roberts & Godbole, 2015;Rymaszewski & Breakwell, 2013;Umpierrez et al, 2013). In fact, Umpierrez et al, 2013 found that SSI patients who missed their insulin doses or received higher medication doses had more statistically significant hyperglycemic events (Umpierrez et al, 2013).…”

“…Although the researcher was not able to determine the hypoglycemic events in this study, Rymaszewski and Breakwell (2013) Elliott et al (2016) found that it is also important to use HbA1c as platform targets to understand higher hypoglycemic event rates because patients might present with no symptoms, patients and nurses might not notice no symptoms, and they might underreport events. The study outcomes, which were consistent with Elliott et al's (2016) findings, indicated that the retrospective chart review could likely underestimate the real incidence of glycemic control, as compared with the prospective study.…”

“…The first goal was to determine the significant difference in blood glucose levels between BBI and SSI on fasting, mean and discharge. The difference was supported by the fasting blood glucose values, which showed SSI were higher than BBI (SSI 201.4; BBI 135.5; p <.001), the mean blood glucose values were higher Several studies demonstrated the clinical benefits (Fahim et al, 2015) and better glycemic control of using BBI over SSI (Roberts & Godbole, 2015;Rymaszewski & Breakwell, 2013;Umpierrez et al, 2013). For example, the SSI patients who missed their insulin doses or received higher medication doses had more severe hyperglycemic events (Umpierrez et al, 2013).…”

“…A classic retrospective chart review conducted by Rymaszewski and Breakwell (2013), the differences between the BBI and SSI were investigated using a convenience sample of 128 T2DM in-patients who were between 18-80 years old in the medical units at a teaching hospital. They reviewed BBI and SSI regimens of patients who did not eat, abnormal glucose levels in the blood, length of stay (LOS) and events of hypoglycemia.…”

Efektifitas Lembar Pemantauan Insulin Terintegrasi Untuk Mengurangi Kejadian Hipoglikemia Pada Pasien Diabetes Mellitus Tipe 2

“…Meskipun demikian, pada kondisi tertentu sasaran kendali glikemik pada A1C di bawah 7,5%. Terapi insulin merupakan metode yang direkomendasikan untuk dapat mengontrol kadar glikemik pada pasien diabetes dan memiliki nilai prediktif yang kuat untuk komplikasi diabetes (CDC, 2007;ADA, 2010;Rymaszewski & Breakwell, 2013).…”