Bedtime sliding scale insulin is unnecessary for hospitalized patients with bedtime glucose < 300 mg/dL: A nudge-based quasi-experiment

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-08-22 DOI:10.1016/j.diabres.2025.112428

James H. Flory , Emily A. Vertosick , Gilad Kuperman , Jessica S. Ancker , Scott Kim , Christine Fitzpatrick , Kimberly Gould , Everett Weiss , Andrew J. Vickers

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引用次数: 0

Abstract

Aims

Bedtime rapid-acting insulin is commonly given to hospitalized patients with moderate hyperglycemia. Its effectiveness has been evaluated in one randomized controlled trial (RCT), the results of which might not generalize to specific populations such as cancer patients.

Methods

An order set encouraging use of rapid-acting bedtime insulin was replaced with one defaulting to rapid-acting bedtime insulin only for glucoses ≥300 mg/dL, deployed over a two-month period in which approximately half of providers were arbitrarily assigned to the new order set. Analysis assessed the effect of the new order set on whether a less-aggressive bedtime sliding scale was actually ordered and mean morning glucose levels.

Results

An inpatient insulin order set was placed for 458 patients. Exposure to the new order set was associated with a 91 % (95 % CI 87 % to 95 %) increase in use of the less-aggressive sliding scale. Mean morning glucose decreased by 16 mg/dL (95 % CI −16 to −1.1 mg/dL, p = 0.035).

Conclusion

These results show it is unnecessary to give rapid-acting bedtime insulin for glucoses <300 mg/dL. Further research should be conducted using changes in the order set as a way of conducting well-controlled trials at low cost with minimum disruption to usual clinical care.

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睡前血糖< 300 mg/dL的住院患者无需使用睡前滑动刻度胰岛素：一项基于轻推的准实验

目的：睡前速效胰岛素常用于中度高血糖住院患者。它的有效性已经在一项随机对照试验（RCT）中进行了评估，其结果可能无法推广到特定人群，如癌症患者。方法将鼓励使用速效睡前胰岛素的医嘱组替换为仅在血糖≥300 mg/dL时才默认使用速效睡前胰岛素的医嘱组，为期2个月，其中大约一半的医疗服务提供者被随机分配到新的医嘱组。分析评估了新顺序的影响，即是否真的安排了一个不那么激进的睡前滑动秤和平均早晨血糖水平。结果为458例患者设置了住院胰岛素订购单。暴露于新订单集与91% （95% CI 87%至95%）的低侵略性滑动量表的使用增加相关。平均早晨血糖下降16 mg/dL （95% CI - 16至- 1.1 mg/dL, p = 0.035）。结论：空腹血糖≤300 mg/dL时，无需使用速效睡前胰岛素。进一步的研究应采用改变顺序的方法，以低成本进行控制良好的试验，同时尽量减少对常规临床护理的干扰。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.