title: Comparison of Inpatient Glycemic Control with Insulin Vials Versus Insulin Pens in General Medicine Patients.
abstract: BACKGROUND
  The Institute for Safe Medication Practices has recommended against routine use of insulin pen devices for inpatients, but the quality of inpatient glycemic control that is achieved with insulin pens versus insulin vials and syringes has not been compared.
  
  
  OBJECTIVE
  To evaluate the quality of glycemic control achieved with insulin vials versus insulin pens in type 2 diabetic general medicine patients.
  
  
  METHODS
  This retrospective cohort study compared glycemic control between 2 groups of patients on rapid-acting insulin protocols: those receiving insulin via patient-specific pen devices and those receiving insulin from patient-specific vials. Patients on a prespecified subacute care floor with a diagnosis of type 2 diabetes and at least 24 hours of glucose monitoring while on an insulin protocol with insulin lispro were included. Glycemic control was compared by area under the curve (AUC) estimations of average overall glucose and average glucose above, below, and within goal range (70-180 mg/dL). Percentages of time above, below, and within goal range were also compared.
  
  
  RESULTS
  The mean ± SD AUC-estimated average glucose for pens was 160 ± 39 mg/dL compared to 158 ± 45 mg/dL for vials (P = .752). The mean ± SD percentage time within goal range was 68.2% ± 28.1% in the pen group versus 69.4% ± 31.8% percent in the vial group (P = .825). No statistically significant differences were detected between those receiving pens or vials for any outcome before and after adjusting for baseline differences and significant covariates.
  
  
  CONCLUSIONS
  Glycemic control did not differ based on insulin delivery system.
authors.affiliation: PGY2 Pharmacy Resident, University of New Mexico College of Pharmacy , Albuquerque, New Mexico.
authors.forename: Juliann
authors.initials: J
authors.lastname: Horne
authors.affiliation: Assistant Professor - Clinician Educator, University of New Mexico College of Pharmacy , Albuquerque, New Mexico.
authors.forename: Rucha
authors.initials: R
authors.lastname: Bond
authors.affiliation: ED/ICU Clinical Pharmacy Lead, University of New Mexico Hospitals , Albuquerque, New Mexico .
authors.forename: Preeyaporn
authors.initials: P
authors.lastname: Sarangarm
keywords: blood glucose; diabetes mellitus; drug delivery systems; injections; inpatient; insulin; subcutaneous; type 2