title: Mealtime Insulin Dosing by Carbohydrate Counting in Hospitalized Cardiology Patients: A Retrospective Cohort Study.
abstract: BACKGROUND
  Carbohydrate counting may improve glycemic control in hospitalized cardiology patients by providing individualized insulin doses tailored to meal consumption. The purpose of this study was to compare glycemic outcomes with mealtime insulin dosed by carbohydrate counting versus fixed dosing in the inpatient setting.
  
  
  METHODS
  This single-center retrospective cohort study included 225 adult medical cardiology patients who received mealtime, basal, and correction-scale insulin concurrently for at least 72 h and up to 7 days in the interval March 1, 2010-November 7, 2013. Mealtime insulin was dosed by carbohydrate counting or with fixed doses determined prior to meal intake. An inpatient diabetes consult service was responsible for insulin management. Exclusion criteria included receipt of an insulin infusion. The primary end point compared mean daily postprandial glucose values, whereas secondary end points included comparison of preprandial glucose values and mean daily rates of hypoglycemia.
  
  
  RESULTS
  Mean postprandial glucose level on Day 7 was 204 and 183 mg/dL in the carbohydrate counting and fixed mealtime dose groups, respectively (unadjusted P=0.04, adjusted P=0.12). There were no statistical differences between groups on Days 2-6. Greater rates of preprandial hypoglycemia were observed in the carbohydrate counting cohort on Day 5 (8.6% vs. 1.5%, P=0.02), Day 6 (1.7% vs. 0%, P=0.01), and Day 7 (7.1% vs. 0%, P=0.008). No differences in postprandial hypoglycemia were seen.
  
  
  CONCLUSIONS
  Mealtime insulin dosing by carbohydrate counting was associated with similar glycemic outcomes as fixed mealtime insulin dosing, except for a greater incidence of preprandial hypoglycemia. Additional comparative studies that include hospital outcomes are needed.
authors.affiliation: 1 Department of Pharmacy Services, Mayo Clinic , Rochester, Minnesota.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Thurber
authors.affiliation: 2 Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Dierkhising
authors.affiliation: 3 Department of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic , Rochester, Minnesota.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Reiland
authors.affiliation: 4 Department of Nursing, Mayo Clinic , Rochester, Minnesota.
authors.forename: Kristina K
authors.initials: KK
authors.lastname: Pearson
authors.affiliation: 3 Department of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic , Rochester, Minnesota.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Smith
authors.affiliation: 1 Department of Pharmacy Services, Mayo Clinic , Rochester, Minnesota.
authors.forename: John G
authors.initials: JG
authors.lastname: O'Meara
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D058065:Diabetic Cardiomyopathies / Q000097:blood / Q000188:drug therapy*; D004040:Dietary Carbohydrates / Q000032:analysis*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D062407:Meals; D008875:Middle Aged; D019518:Postprandial Period; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007004:Hypoglycemic Agents; D007328:Insulin