Dr. Knees
Clinical question: In patients with mild hyperglycemia on admission, can sliding scale insulin (SSI) alone be used for blood glucose (BG) control?
Background: Prior randomized controlled trials (RCTs) have demonstrated better glycemic control with basal-bolus insulin protocols for hospitalized patients with type 2 diabetes (T2D). However, SSI-only regimens remain common. This study questioned whether SSI alone may be appropriate for a subset of hospitalized patients.
Study design: Retrospective cohort study.
Setting: Emory Healthcare hospitals in Atlanta.
Synopsis: In patients with T2D admitted to non-critical care settings, 31.4% received SSI alone. Within the SSI cohort, if admitted with BG <140 mg/dL, 86% achieved target glycemic control (BGs 70–180 without hypoglycemia <70). If admitted with BGs 140–180, 83% achieved glycemic control. However, if admitted with BGs 180–250 only 53% achieved control, which further declined to 18% with BGs ≥250. No cohort was treated initially with basal-bolus insulin, so comparisons to traditional basal-bolus regimens were not possible.
Bottom line: In patients with T2D who are admitted to non-critical care services with mild hyperglycemia, management with SSI alone may be sufficient.
Citation: Migdal AL et al. Inpatient glycemic control with sliding scale insulin in noncritical patients with type 2 diabetes: Who can slide? J Hosp Med. 2021 Aug; 16(8):462-468. doi 10.12788/jhm.3645.
Dr. Knees is chief resident in quality and patient safety at the University of Colorado School of Medicine hospital medicine section, Rocky Mountain Regional VA Medical Center, Aurora, Colo.