Glycemic Management in Insulin Naive Patients in the Inpatient Setting

Q3 Medicine
M. Goldstein, Shahidul Islam, Sophie Nicolich-Henkin, Lauren Bellavia, Stanislaw Klek
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引用次数: 0

Abstract

The ideal inpatient insulin regimen efficiently attains the target blood glucose range, effectively treats hyperglycemia, and minimizes the risk of hypoglycemia. The objective of this study was to compare glycemic targets achieved by using correctional monotherapy (CM) and basal-bolus therapy (BBT) in insulin-naive patients in the inpatient setting to determine optimal blood glucose management for these patients. This was a retrospective observational cohort study of 792 patients with diabetes not on home insulin therapy who were admitted to an academic hospital over a 5.5-month period. The percentage of hyperglycemic and hypoglycemic values in each group were compared. Among the 3,112 measured blood glucose values obtained from 792 patients within the first 24 hours of insulin administration, 28.5% were hyperglycemic in the BBT group compared with 23.5% in the CM group. When adjusted for covariates, there was a 23% decrease in hyperglycemia in the BBT group (incidence rate ratio = 0.77, 95% CI 0.64–0.95, P = 0.006). Increases in A1C and admission blood glucose, as well as decreases in admission creatinine and inpatient steroid use, were independently associated with higher rates of hyperglycemia, adjusted for all other covariates. There was no significant difference between the groups in the rate of hypoglycemia, which was 1.9% in the BBT group and 1.4% in the CM group (P = 0.301). Utilizing BBT in insulin-naive patients admitted to the hospital within the first 24 hours of insulin administration results in lower rates of hyperglycemia without higher rates of hypoglycemia when compared with CM.
住院环境中胰岛素无效患者的血糖管理
理想的住院患者胰岛素治疗方案应能有效达到目标血糖范围,有效治疗高血糖,并将低血糖风险降至最低。本研究的目的是比较胰岛素无效患者在住院期间使用纠正单药疗法(CM)和基础加量疗法(BBT)所达到的血糖目标,以确定这些患者的最佳血糖管理方案。 这是一项回顾性观察队列研究,研究对象是一家学术医院在 5.5 个月内收治的 792 名未在家接受胰岛素治疗的糖尿病患者。研究比较了各组中高血糖值和低血糖值的比例。 在 792 名患者注射胰岛素后 24 小时内测量的 3112 个血糖值中,BBT 组有 28.5%的患者血糖过高,而 CM 组只有 23.5%。经协变因素调整后,BBT 组的高血糖发生率降低了 23%(发生率比 = 0.77,95% CI 0.64-0.95,P = 0.006)。经所有其他协变量调整后,A1C 和入院血糖的升高以及入院血肌酐和住院类固醇使用量的降低与高血糖发生率的升高独立相关。各组之间的低血糖发生率无明显差异,BBT 组为 1.9%,CM 组为 1.4%(P = 0.301)。 与 CM 相比,在胰岛素用药后 24 小时内入院的胰岛素无效患者使用 BBT 可降低高血糖发生率,但不会增加低血糖发生率。
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来源期刊
Diabetes Spectrum
Diabetes Spectrum Medicine-Internal Medicine
CiteScore
2.70
自引率
0.00%
发文量
62
期刊介绍: The mission of Diabetes Spectrum: From Research to Practice is to assist health care professionals in the development of strategies to individualize treatment and diabetes self-management education for improved quality of life and diabetes control. These goals are achieved by presenting review as well as original, peer-reviewed articles on topics in clinical diabetes management, professional and patient education, nutrition, behavioral science and counseling, educational program development, and advocacy. In each issue, the FROM RESEARCH TO PRACTICE section explores, in depth, a diabetes care topic and provides practical application of current research findings.
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