Gagandeep Kaur1, Brandon Markley, Karen Schlauch, Kenneth E Izuora. 1. Department of Internal Medicine (GK, BM, KEI), University of Nevada School of Medicine, Las Vegas, Nevada; Department of Pharmacy (BM), University Medical Center, Las Vegas, Nevada; and Department of Biochemistry/Molecular Biology (KS), Nevada Center for Bioinformatics, University of Nevada, Reno, Nevada.
Abstract
BACKGROUND: This study looked at the effect of replacing an intensive subcutaneous insulin correction protocol (old subcutaneous insulin correction protocol [OP]) with a less intensive protocol (new subcutaneous insulin correction protocol [NP]) in a tertiary hospital with the hypothesis that using the NP will result in less hypoglycemia and improved hospital outcomes. METHODS: The charts for 200 hospitalized patients managed with the OP (glycemic target 90-116 mg/dL for intensive care and 90-130 mg/dL for nonintensive care patients) and 200 with the NP (glycemic target 150-200 mg/dL) were reviewed. Data were collected and analyzed using Fisher's exact test and Student's t test. The primary outcome was the difference in hypoglycemia rates between the 2 protocols. Hypothesis test P values of <0.05 were deemed significant. RESULTS: There was no statistically significant difference in age, sex, ethnicity, body mass index, level of hospital care or use of scheduled insulin for the 2 groups (P > 0.05 for all). Average blood glucose values were 160.45 and 169.98 mg/dL for the OP and NP, respectively (P = 0.063). There were 14 readings ≤ 40 mg/dL in the OP compared with 6 in the NP (P = 0.046). With the OP, 27 patients required dextrose treatment compared to 11 with the NP (P = 0.0097). The average length of hospitalization was longer for the NP compared with the OP (13.16 versus 6.56 days, P = 0.00085). CONCLUSIONS: A less intensive subcutaneous insulin correction protocol in hospitalized patients resulted in similar glucose values with less severe hypoglycemia. However, it was associated with longer length of hospitalization.
BACKGROUND: This study looked at the effect of replacing an intensive subcutaneous insulin correction protocol (old subcutaneous insulin correction protocol [OP]) with a less intensive protocol (new subcutaneous insulin correction protocol [NP]) in a tertiary hospital with the hypothesis that using the NP will result in less hypoglycemia and improved hospital outcomes. METHODS: The charts for 200 hospitalized patients managed with the OP (glycemic target 90-116 mg/dL for intensive care and 90-130 mg/dL for nonintensive care patients) and 200 with the NP (glycemic target 150-200 mg/dL) were reviewed. Data were collected and analyzed using Fisher's exact test and Student's t test. The primary outcome was the difference in hypoglycemia rates between the 2 protocols. Hypothesis test P values of <0.05 were deemed significant. RESULTS: There was no statistically significant difference in age, sex, ethnicity, body mass index, level of hospital care or use of scheduled insulin for the 2 groups (P > 0.05 for all). Average blood glucose values were 160.45 and 169.98 mg/dL for the OP and NP, respectively (P = 0.063). There were 14 readings ≤ 40 mg/dL in the OP compared with 6 in the NP (P = 0.046). With the OP, 27 patients required dextrose treatment compared to 11 with the NP (P = 0.0097). The average length of hospitalization was longer for the NP compared with the OP (13.16 versus 6.56 days, P = 0.00085). CONCLUSIONS: A less intensive subcutaneous insulin correction protocol in hospitalizedpatients resulted in similar glucose values with less severe hypoglycemia. However, it was associated with longer length of hospitalization.
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Authors: Denise E Bonds; Michael E Miller; Richard M Bergenstal; John B Buse; Robert P Byington; Jeff A Cutler; R James Dudl; Faramarz Ismail-Beigi; Angela R Kimel; Byron Hoogwerf; Karen R Horowitz; Peter J Savage; Elizabeth R Seaquist; Debra L Simmons; William I Sivitz; Joann M Speril-Hillen; Mary Ellen Sweeney Journal: BMJ Date: 2010-01-08