title: Transition from intravenous to subcutaneous insulin: effectiveness and safety of a standardized protocol and predictors of outcome in patients with acute coronary syndrome.
abstract: OBJECTIVE
  The study objectives were 1) to assess the effectiveness and safety of a standardized protocol for the transition to subcutaneous insulin and oral feeding in diabetic or hyperglycemic patients with acute coronary syndrome (ACS) who were receiving intravenous insulin and glucose at the time of the transfer from the intensive cardiac care unit to a general ward and 2) to identify predictors of transition outcome.
  
  
  METHODS
  This was a prospective observational study. The protocol specifies that patients receive a 100% of their daily subcutaneous insulin requirement from the first day of oral feeding, calculated from the intravenous insulin rate during the final 12 h divided into two: 50% basal and 50% prandial.
  
  
  RESULTS
  In 142 patients (93 male, 49 female, age range 47-88 years, 135 with known diabetes) the first day after transition, 44.8% of blood glucose (BG) measurements were within the strict range of 100-140 mg/dL before meals and 100-180 mg/dL after meals, and 70.8% were within the broader ranges of 80-160 mg/dL and 80-200 mg/dL, respectively. Pre- or postprandial hypoglycemia (BG<70 mg/dL) occurred in 11 patients (7.7%) on the first day and in 38 patients (26.8%) on the first 3 days after transition. Old age, high doses of intravenous insulin, and wide BG variations in the 24 h before insulin infusion was stopped were predictive of poor BG control after transition.
  
  
  CONCLUSIONS
  This study shows the effectiveness and safety of a standardized protocol for the transition from intravenous to subcutaneous insulin in patients with ACS when regular oral feeding was resumed.
authors: Division of Cardiology and Intensive Cardiac Care Unit, Ospedale di Desio, Desio, Italy. fausto.avanzini@marionegri.it
authors: Fausto
authors: F
authors: Avanzini
authors: Giuseppe
authors: G
authors: Marelli
authors: Walter
authors: W
authors: Donzelli
authors: Giovanna
authors: G
authors: Busi
authors: Stefania
authors: S
authors: Carbone
authors: Laura
authors: L
authors: Bellato
authors: Elena Lucia
authors: EL
authors: Colombo
authors: Roberto
authors: R
authors: Foschi
authors: Emma
authors: E
authors: Riva
authors: Maria Carla
authors: MC
authors: Roncaglioni
authors: Mario
authors: M
authors: De Martini
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