Effects of preprandial versus postprandial nutritional insulin administration in the inpatient setting.

Diabetes Hospitalized Hyperglycemia Hypoglycemia Inpatient Insulin Patient safety

Journal

Diabetes research and clinical practice
ISSN: 1872-8227
Titre abrégé: Diabetes Res Clin Pract
Pays: Ireland
ID NLM: 8508335

Informations de publication

Date de publication:
15 Jul 2024
Historique:
received: 11 04 2024
revised: 07 07 2024
accepted: 14 07 2024
medline: 18 7 2024
pubmed: 18 7 2024
entrez: 17 7 2024
Statut: aheadofprint

Résumé

Hospitalized patients can have inconsistent nutritional intake due to acute illness, changing diet, or unpredictable meal delivery. The aim of this study was to evaluate whether implementation of a hospital-wide policy shifting nutritional insulin administration from pre-meal to post-meal was associated with changes in glycemic control or length of stay (LOS). This retrospective study performed at a community hospital evaluated adult inpatients receiving nutritional insulin across three time periods. pre-intervention, immediate post-intervention, and distant post-intervention. Outcomes included rates of hypoglycemia (glucose ≤ 70 mg/dL), moderate hypoglycemia (<54 mg/dL), severe hypoglycemia (≤40 mg/dL), severe hyperglycemia (≥300 mg/dL), daily mean glucose level, and LOS. The number of patient-days analyzed across the cohorts were 1948, 1751, and 3244, respectively. After multivariate adjustment, risk of developing any hypoglycemia and severe hypoglycemia significantly decreased over time (p = 0.001 and p = 0.009, respectively). Daily mean glucose increased over time (194.6 ± 62.5 vs 196.8 ± 65.5 vs 199.3 ± 61.5 mg/dL; p = 0.003), but there were no significant differences among rates of severe hyperglycemia (p = 0.10) or LOS (p = 0.74). Implementing a hospital-wide shift to postprandial nutritional insulin administration significantly reduced hypoglycemia rates without increasing severe hyperglycemia. This suggests a promising strategy for improving patient safety, but further prospective randomized controlled trials are warranted to confirm these findings.

Identifiants

DOI: 10.1016/j.diabres.2024.111785 PMID: 39019331
pubmed: 39019331
pii: S0168-8227(24)00695-8
doi: 10.1016/j.diabres.2024.111785
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

111785

Informations de copyright

Copyright © 2024. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.P.D. has received grant funding from DexCom, Inc for an unrelated outpatient study in patients with T1D. M.Z. discloses consulting for DexCom, Inc. and EMD Serono. All other authors have no declarations of interest

Auteurs

Merit George (M)

Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA.

Mihail Zilbermint (M)

Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA; Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, 6225 Smith Ave., Suite B-300, Baltimore, MD 21209, USA; Suburban Hospital, Johns Hopkins Medicine, 8600 Old Georgetown Road, Bethesda, MD 20814, USA.

Sam Sokolinsky (S)

JHHS Quality and Clinical Analytics, Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD 21209, USA.

Kristine Batty (K)

Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, 6225 Smith Ave., Suite B-300, Baltimore, MD 21209, USA; Suburban Hospital, Johns Hopkins Medicine, 8600 Old Georgetown Road, Bethesda, MD 20814, USA.

Mahsa Motevalli (M)

Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, 6225 Smith Ave., Suite B-300, Baltimore, MD 21209, USA; Suburban Hospital, Johns Hopkins Medicine, 8600 Old Georgetown Road, Bethesda, MD 20814, USA.

Camille Stanback (C)

Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA; Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, 6225 Smith Ave., Suite B-300, Baltimore, MD 21209, USA; Sibley Memorial Hospital, Johns Hopkins Medicine, 5255 Loughboro Rd NW, Washington, DC 20016, USA.

Eva Gonzales (E)

Johns Hopkins Howard County Medical Center, Johns Hopkins Medicine, 5755 Cedar Ln, Columbia, MD 20794, USA.

Catherine Miller (C)

Johns Hopkins Howard County Medical Center, Johns Hopkins Medicine, 5755 Cedar Ln, Columbia, MD 20794, USA.

Lynette Sequeira (L)

Department of Internal Medicine, Johns Hopkins University School of Medicine, 2024 E Monument St, Baltimore, MD 21287.

Andrew P Demidowich (AP)

Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA; Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, 6225 Smith Ave., Suite B-300, Baltimore, MD 21209, USA; Johns Hopkins Howard County Medical Center, Johns Hopkins Medicine, 5755 Cedar Ln, Columbia, MD 20794, USA. Electronic address: ademido1@jhmi.edu.

Classifications MeSH