SAT-LB026 Basal-Prandial Insulin versus Basal-Sliding-Scale Insulin in the Management of Hyperglycemia in Non-Critically Ill Hospitalized Patients

Abstract

Background: Hyperglycemia in hospitalized patients is a common occurrence and is associated with adverse outcomes. Randomized trials indicated that a basal-prandial Insulin regimen (BPI) is preferred over sliding-scale insulin (SSI) alone in hospitalized patients. BPI is now considered a standard of care while the use of SSI alone has been discouraged. However, the use of a basal insulin with a sliding-scale Insulin (BSSI) instead of BPI remains prevalent. There has been no study that compared the efficacy and safety of these 2 insulin regimens: BPI vs BSSI. The aim of the study: This study was conducted to compare the efficacy and safety of the 2 insulin regimens, BPI vs BSSI, in hospitalized patients. Study design: Adult, non-pregnant patients with DM who were admitted to medical-surgical floors in a community hospital from 8/1/2015 to 8/31/2015 were included in this retrospective study. Inclusion criteria included admitting blood glucose (BG) of over 300 mg/dL or recent A1c of over 9% or home insulin use in those who were eating regular meals during the hospital stay and who were admitted for a least 3 days. Exclusion criteria were those who were NPO for longer than 48 hours, those on tube feeding or TPN and those required insulin infusion. Results and discussion: A total of 24 patients in BPI and 43 in BSSI were studied. There was no significant difference in age (55.3 vs 58.2 years), gender (female 38.5% vs 55.8%), ethnicity (Hispanics 57.7% vs 58.1%), those with T2DM (92.3% vs 100%), home insulin use (100 vs 86%) or A1c result (9.76 vs 11.4%) between BPI and BSSI (all P > 0.05). Hypoglycemia with BG <70 mg/dL was observed in 11.5% (3/26) in BPI and 27.9% (12/43) in BSSI (P=0.1128). Total days of hypoglycemia (any day with one or more episodes of hypoglycemia) was 3 (mean 0.12 day per patient) in BPI and 15 (mean 0.35 day per patient) in BSSI (p=0.0777). Therefore there was a trend towards higher hypoglycemia risk in BSSI. The 92.3% (24/26) in BPI and 69.8% (30/43) in BSSI had at least one episode of severe hyperglycemia with BG >250 (p=0.029). Total days of hyperglycemia (any day with one or more episodes of severe hyperglycemia) was 87 (mean 3.35 days per patient) in BPI and 114 (mean 2.65 days per patient) in BSSI (p=0.344). Mean BG during hospital stay was 206.7 ±41.3 in BPI and 177.5 ±44.8mg/dL in BSSI (P=0.0087). Therefore it appeared that BSSI is associated with the lower risk of hyperglycemia. There was no significant difference in mortality (0% in both groups) and total hospital length of stay (7.12 vs 6.19 days) between BPI and BSSI. Conclusions: There was a trend towards a lower risk of hypoglycemia with Basal-Bolus Insulin as compared to Basal-Sliding-Scale Insulin. However, BSSI use was associated with a lower risk of severe hyperglycemia. This study result should be confirmed with larger studies with more patient numbers. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts ...