入院时管理浓缩格列奈胰岛素和地格鲁德胰岛素时确保患者安全

IF 1.3 Q4 PHARMACOLOGY & PHARMACY
Denise Kelley Pharm.D., Janci Addison Pharm.D., Kristin Janzen Pharm.D., Steven Wulfe Pharm.D.
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引用次数: 0

摘要

近年来,浓缩胰岛素的开发和使用有所增加。这给住院患者在过渡到非浓缩胰岛素时带来了独特的挑战。关于住院环境中各种浓缩胰岛素的推荐换用方法,目前尚无明确的共识,有的建议实施 1:1 单位剂量转换,有的建议至少减少 20% 的剂量,还有的建议根据浓缩胰岛素的每日总剂量来选择换用方法。在一家医疗系统进行的一项回顾性队列分析中发现,将格列奈胰岛素 300 单位/毫升(iGlar300)按 1:1 单位转换为地特米胰岛素 100 单位/毫升(iDet100)时,发生低血糖事件的数量要多于将格列奈胰岛素 100 单位/毫升(iGlar100)转换为地特米胰岛素 100 单位/毫升(iDet100)时。这促使我们寻找一种既能提高患者安全性,又能在多医院网络中可行的标准化方法。从 iGlar300 过渡到 iDet100 后,至少减少 20% 剂量的解决方案成功改善了低血糖发生率,但也面临许多后勤挑战。虽然 iDet100 正在逐步退出市场,但在从 iGlar300 过渡到 iGlar100 时,建议采用至少减少 20% 剂量的方法,而这一挑战仍是一个相关问题。在从浓缩基础胰岛素过渡到非浓缩基础胰岛素时,确保医疗系统具备实施剂量减少的能力对于维护患者安全至关重要。本文将讨论在将 iGlar300 和胰岛素 degludec 200 单位/毫升(iDeg200)过渡到非浓缩型基础胰岛素时,支持最佳剂量的现有有限证据,并根据一家医疗系统在处理这一新兴患者安全问题时所采用的方法,为其他医疗系统提供 "如何 "实施指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ensuring patient safety when managing concentrated insulin glargine and insulin degludec at hospital admission

The development and use of concentrated insulins have increased in recent years. This can pose unique challenges when transitioning to a non-concentrated insulin during an inpatient admission. There is no clear consensus on the recommended interchange of the various concentrated insulins in the inpatient setting, with suggestions ranging from implementing a 1:1 unit dose conversion, a minimum 20% dose reduction or selecting an approach based on the total daily dose of the concentrated insulin. In a retrospective cohort analysis at a single health system, a greater number of hypoglycemic events occurred when implementing a 1:1 unit conversion of insulin glargine 300 units/mL (iGlar300) to insulin detemir 100 units/mL (iDet100) compared to the same conversion from insulin glargine 100 units/mL (iGlar100) to iDet100. This prompted identification of a standardized approach that would improve patient safety while also being operationally feasible at a multi-hospital network. The solution of implementing a minimum 20% dose reduction successfully improved hypoglycemia rates upon transitioning from iGlar300 to iDet100, though many logistical challenges were faced. Although iDet100 is being phased off the market, adhering to this minimum 20% dose reduction is the recommended approach when transitioning from iGlar300 to iGlar100, and this challenge persists as a relevant issue. Ensuring health systems are equipped to implement dose reductions when transitioning from concentrated basal insulins to non-concentrated basal insulin counterparts is paramount for maintaining patient safety. This paper will discuss the limited evidence available supporting optimal dosing when transitioning iGlar300 and insulin degludec 200 units/mL (iDeg200) to non-concentrated basal insulins and serve as a “how to” implementation guide for other health systems, based on one health system's approach in navigating this emerging patient safety issue.

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CiteScore
2.70
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