TY - JOUR
T1 - Associations between home insulin dose adjustments and glycemic outcomes at hospital admission
AU - Khan, Saira
AU - Golden, Sherita Hill
AU - Mathioudakis, Nestoras
N1 - Funding Information:
This work was supported by the National Institutes of Health 1K23DK111986-01.
Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Aims To describe patterns of home insulin dose adjustments for non-surgical, non-critically ill patients at admission and to describe associations between these adjustments and inpatient glycemic control. Methods Hospital records of non-critically ill patients treated with basal insulin prior to admission were identified. After exclusion of records in which a confounding factor influencing insulin dosing was present, 258 patient-admissions over a 3-year time period were included. Multivariate logistic regression was used to analyze the association between adjustments to home insulin total daily dose (TDD) and inpatient glycemic control within the first 48 h, adjusting for relevant confounders. Results On hospital days 1 (HD1) and 2 (HD2), the home insulin TDD was reduced by 43.5% and 23.9%, respectively. Reductions in the home TDD ranging from 10% to 50% were not associated with normoglycemia or hyperglycemia, whereas increases ranging from 10% to 50% were associated with 2–5-fold increased odds of hyperglycemia. For patients with home insulin TDD ≥0.4 units/kg/day, a weight-based dose of 0.4–0.6 units/kg/day was associated with significantly higher odds of normoglycemia on HD2 (OR 3.99; 95% CI 1.42–11.21) compared to lower doses. Conclusions Compared to less aggressive increases, home insulin dose increases ranging from 10% to 50% were associated with greater odds of hyperglycemia without increased odds of hypoglycemia during early hospitalization. Weight-based insulin dosing may be a preferred strategy for glycemic control among patients whose home TDD is ≥0.4 units/kg/day.
AB - Aims To describe patterns of home insulin dose adjustments for non-surgical, non-critically ill patients at admission and to describe associations between these adjustments and inpatient glycemic control. Methods Hospital records of non-critically ill patients treated with basal insulin prior to admission were identified. After exclusion of records in which a confounding factor influencing insulin dosing was present, 258 patient-admissions over a 3-year time period were included. Multivariate logistic regression was used to analyze the association between adjustments to home insulin total daily dose (TDD) and inpatient glycemic control within the first 48 h, adjusting for relevant confounders. Results On hospital days 1 (HD1) and 2 (HD2), the home insulin TDD was reduced by 43.5% and 23.9%, respectively. Reductions in the home TDD ranging from 10% to 50% were not associated with normoglycemia or hyperglycemia, whereas increases ranging from 10% to 50% were associated with 2–5-fold increased odds of hyperglycemia. For patients with home insulin TDD ≥0.4 units/kg/day, a weight-based dose of 0.4–0.6 units/kg/day was associated with significantly higher odds of normoglycemia on HD2 (OR 3.99; 95% CI 1.42–11.21) compared to lower doses. Conclusions Compared to less aggressive increases, home insulin dose increases ranging from 10% to 50% were associated with greater odds of hyperglycemia without increased odds of hypoglycemia during early hospitalization. Weight-based insulin dosing may be a preferred strategy for glycemic control among patients whose home TDD is ≥0.4 units/kg/day.
KW - Basal
KW - Glucose
KW - Hospitalization
KW - Hyperglycemia
KW - Hypoglycemia
KW - Insulin
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U2 - 10.1016/j.diabres.2017.02.003
DO - 10.1016/j.diabres.2017.02.003
M3 - Article
C2 - 28319802
AN - SCOPUS:85015662702
SN - 0168-8227
VL - 127
SP - 51
EP - 58
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -