Clinical outcomes associated with the use of subcutaneous insulin-by-glucose sliding scales....

Clinical outcomes associated with the use of subcutaneous insulin-by-glucose sliding scales to manage hyperglycemia in hospitalized patients with pneumonia


Diabetes Research and Clinical Practice, 2007 Dec, vol. 78, no. 3, p.
392-7

Becker-T, Moldoveanu-A, Cukierman-T, Gerstein-HC.

OBJECTIVE: Despite its ubiquitous use, the value of subcutaneous
insulin-by-glucose sliding scales (SISS) for the management of in-
patient hyperglycemia has not been carefully assessed. METHODS: The
medical charts of 391 patients >45 years of age admitted with
pneumonia from January 2003 to May 2004 who had a recorded glucose
within 24h of admission and who did not have active cancer,
tuberculosis or AIDS were reviewed. Abstracted data included
demographics, clinical characteristics, admission and daily glucose
levels, medications, SISS use and clinical outcomes. The primary
outcome was pre-defined as a composite of in-hospital mortality,
cardiovascular complications, sepsis or ICU admission. RESULTS:
Compared to patients not prescribed an SISS during the admission, the
47 patients prescribed an SISS had a higher rate of the following
outcomes: primary outcome (OR=2.55; 95% CI 1.38-4.73); cardiovascular
complications or death (OR=1.86; 95% CI 0.99-3.49), sepsis or ICU
admission (OR=4.98; 95% CI 2.38-10.42). The relationship between
sliding scale use and the primary outcome was statistically
significant, even after controlling for age, sex, diabetes, steroids,
CHF and COPD (P<0.0001). Patients receiving a sliding scale had mean
in-hospital glucose values of 11.83mmol/L versus 7.2mmol/L (P<0.0001)
in patients not receiving an insulin sliding scale. CONCLUSION: Among
patients admitted to a medical ward with pneumonia, an SISS is
associated with higher glucose levels and poorer clinical outcomes.