Comparison on Efficacy and Safety of Three Inpatient Insulin Regimens for Management of Non-Critical Patients with Type 2 Diabetes

Eman Said, Samar Farid, Nirmeen Sabry, May Fawzi

Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Departments of Internal Medicine, Facultyof Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt..

DOI: 10.4236/pp.2013.47080                

Abstract

Background: Hyperglycemia in hospitalized patients is associated with poor clinical outcomes. Scheduled Subcutaneous Insulin therapy has been recommended for better glycemic control. Aims: To compare efficacy and safety of traditional sliding scale insulin (SSI) versus modified 70/30 insulin versus basal plus supplemental scale (SS) insulin regimens for glycemic control of inpatients with diabetes. Methods: In a prospective trial, 62 patients with diabetes were randomized to receive either hospital SSI (N = 22), or twice daily 70/30 insulin plus supplemental lunchtime insulin for BG ≥ 150 mg/dL (N = 21) or once every night glargine plus prandial glulisine for BG ≥ 150 mg/dL (N = 19). 70/30 insulin and glargine were started respectively at 0.4 and 0.2 U/kg/day for BG ≤ 200 mg/dL or 0.5 and 0.3 U/kg/day for BG above 200 mg/dL. Results: Starting at BG level of 204 ± 68, 200 ± 50 and 241 ± 94 mg/dL in SSI, 70/30 insulin and glargine/glulisine groups respectively, (F(2,35.47) = 1.467, p = 0.244, Welch test), mean daily BG after first day of hospitalization was statistically significant (F(2,35.58) = 7.043, p = 0.003, Welch test) lower in 70/30 insulin group (171 ± 38 mg/dL) compared to (218 ± 71 mg/dL) in SSI group (p = 0.026) and (225 ± 65 mg/dL) in glargine/glulisine group (p = 0.01). Conclusions: With poorly educated nursing staff, basal plus SS insulin failed to provide adequate glycemic control. However, tailored 70/30 insulin regimen resulted in statistically significant glycemic control compared to traditional SSI.

Keywords

Type 2 DM; Sliding Scale Insulin; 70/30 Insulin; Basal Insulin; Supplemental Insulin

Conflicts of Interest

The authors declare no conflicts of interest.

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