This article is more than 5 years old. Information may no longer be current.
High-dose insulin glargine restriction reduces inpatient hypoglycemia in type 2 diabetes
Limiting orders of high doses of insulin glargine to endocrine staff members may reduce insulin-related hypoglycemia in hospitalized patients with type 2 diabetes without worsening glycemic control, study data show.
“Hypoglycemia in hospitalized patients is associated with poor outcomes, even though data is not as robust as in the outcomes of hyperglycemia in hospitalized patients,” Sun Y. Lee, MD, ECNU, instructor of medicine in the section of endocrinology, diabetes and nutrition at Boston University School of Medicine, told Endocrine Today. “A safety measure limiting large doses of glargine administration in hospitalized patients to reduce the risk of iatrogenic hypoglycemia was implemented at our institution. After the implementation, less patients received high-dose glargine on admission, and the overall incidence of hypoglycemia early during the hospitalization decreased without compromising glycemic control.”
In May 2013, inpatient ordering of high glargine doses ( 5 u/kg per day) was restricted to endocrine staff at Boston Medical Center, according to the study.
Lee and colleagues evaluated 692 adults hospitalized who received glargine upon admission to Boston Medical Center before restriction (Nov. 1, 2012 to April 30, 2013) and 651 adults who received glargine upon admission after restriction (Nov. 1, 2013 to April 30, 3014) to determine the effect of restriction on hypoglycemia and glycemic control within 48 hours of admission.
More patients in the pre-restriction group received high glargine doses (5.2%) compared with 0.3% of the post-restriction group (P < .001). Mean blood glucose levels were similar between the two groups within 48 hours of admission. The post-restriction group had significantly lower incidences of hypoglycemia per admission (P < .001) and per blood glucose measurements (P = .001) compared with the pre-restriction group.
Outpatient insulin total daily dose of 1 unit/kg or more was prescribed to more participants in the pre-intervention group (2.8%) compared with the post-intervention group (2.1%).
Participants who received a higher dose of glargine compared with those who did not had higher outpatient prescribed insulin daily dose (P = .042).
“Hospitalized patients may require an insulin regimen different from their outpatient regimen, as illness and change in nutritional status may affect insulin requirements during hospitalization,” Lee told Endocrine Today. “Hospitalized patients may require smaller doses of insulin if they are on very high doses as an outpatient, and avoiding excess insulin dose on admission may decrease risk of hypoglycemia without compromising overall glycemic control. More research in assessment of effectiveness of the weight-based insulin regimen in hospitalized patients, especially in those on high doses of insulin as outpatient would be beneficial in informing the practice guidelines for inpatient glycemic control.” – by Amber Cox
For more information:
Sun Y. Lee, MD, can be reached at Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, 88 East Newton Street, H3600, Boston, MA 02118; email: sun.lee@bmc.org.
Disclosure: The researchers report no relevant financial disclosures.