title: Outcomes of Less Intensive Glycemic Target for a Subcutaneous Insulin Protocol in Hospitalized Patients.
abstract: BACKGROUND
  This study looked at the effect of replacing an intensive subcutaneous insulin correction protocol (old subcutaneous insulin correction protocol [OP]) with a less intensive protocol (new subcutaneous insulin correction protocol [NP]) in a tertiary hospital with the hypothesis that using the NP will result in less hypoglycemia and improved hospital outcomes.
  
  
  METHODS
  The charts for 200 hospitalized patients managed with the OP (glycemic target 90-116 mg/dL for intensive care and 90-130 mg/dL for nonintensive care patients) and 200 with the NP (glycemic target 150-200 mg/dL) were reviewed. Data were collected and analyzed using Fisher's exact test and Student's t test. The primary outcome was the difference in hypoglycemia rates between the 2 protocols. Hypothesis test P values of <0.05 were deemed significant.
  
  
  RESULTS
  There was no statistically significant difference in age, sex, ethnicity, body mass index, level of hospital care or use of scheduled insulin for the 2 groups (P > 0.05 for all). Average blood glucose values were 160.45 and 169.98 mg/dL for the OP and NP, respectively (P = 0.063). There were 14 readings ≤ 40 mg/dL in the OP compared with 6 in the NP (P = 0.046). With the OP, 27 patients required dextrose treatment compared to 11 with the NP (P = 0.0097). The average length of hospitalization was longer for the NP compared with the OP (13.16 versus 6.56 days, P = 0.00085).
  
  
  CONCLUSIONS
  A less intensive subcutaneous insulin correction protocol in hospitalized patients resulted in similar glucose values with less severe hypoglycemia. However, it was associated with longer length of hospitalization.
authors.affiliation: Department of Internal Medicine (GK, BM, KEI), University of Nevada School of Medicine, Las Vegas, Nevada; Department of Pharmacy (BM), University Medical Center, Las Vegas, Nevada; and Department of Biochemistry/Molecular Biology (KS), Nevada Center for Bioinformatics, University of Nevada, Reno, Nevada.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kaur
authors.forename: Brandon
authors.initials: B
authors.lastname: Markley
authors.forename: Karen
authors.initials: K
authors.lastname: Schlauch
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Izuora
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009505:Nevada; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin