HYPOGLYCEMIA RATES AFTER RESTRICTION OF HIGH-DOSE GLARGINE IN HOSPITALIZED PATIENTS.
Endocr Pract. 2016 Aug 19;
Authors: Lee SY, Askin G, McDonnell ME, Arnold LM, Alexanian SM
Abstract
Objective Hypoglycemia remains one of the main challenges of insulin therapy. To reduce insulin-related hypoglycemia at our institution, we restricted inpatient ordering of high glargine doses (≥0.5u/kg/day) to endocrine staff in 5/2013. This retrospective cohort study assesses its effect on hypoglycemia and glycemic control ≤48 hours of admission. Methods 692 adult patients hospitalized at Boston Medical Center and received glargine upon admission from 11/1/12-4/30/13 were identified as the pre-intervention group, and 651 adult patients from 11/1/13-4/30/14 as the post-intervention group. Demographics, medical history, home insulin regimen, concurrent oral diabetes medications or glucocorticoids administration, admission serum creatinine, all blood glucose levels (BG) ≤48hours of admission, and hemoglobin A1c values ≤3months were assessed. Hypoglycemia was defined as BG≤70mg/dL, and hyperglycemia as BG≥200mg/dL. Multivariable regression models assessed potential associations between covariates and incidence of hypoglycemia and average BG ≤48 hours of admission. Results Demographics were similar between groups. Significantly less patients received high-dose glargine in the post-intervention group (5.2% vs. 0.3%; p<0.001). Incidences of hypoglycemia were significantly lower in the post-intervention group (20.9% vs 17.8%; p<0.001 per admission (ADM), and 3.4% vs 2.3%; p=0.001 per blood glucose measurements (BGM)). Mean BG levels ≤48hours of admission and incidence of hyperglycemia were not significantly different. The adjusted incident rate ratio of hypoglycemia was 0.63 per ADM and 0.74 per BMG in postintervention group compared to the pre-intervention group (p=0.001 and p=0.063, respectively). Conclusion We found that implementation of a restriction on high doses of glargine resulted in lower rates of hypoglycemia without worsening glycemic control.
PMID: 27540877 [PubMed - as supplied by publisher]