Associations between home insulin dose adjustments and glycemic outcomes at hospital admission.
OBJECTIVE
To describe patterns of home insulin dose adjustments for non-surgical, non-critically ill patients at admission and to describe associations between these adjustments and inpatient glycemic control.


METHODS
Hospital records of non-critically ill patients treated with basal insulin prior to admission were identified. After exclusion of records in which a confounding factor influencing insulin dosing was present, 258 patient-admissions over a 3-year time period were included. Multivariate logistic regression was used to analyze the association between adjustments to home insulin total daily dose (TDD) and inpatient glycemic control within the first 48h, adjusting for relevant confounders.


RESULTS
On hospital days 1 (HD1) and 2 (HD2), the home insulin TDD was reduced by 43.5% and 23.9%, respectively. Reductions in the home TDD ranging from 10% to 50% were not associated with normoglycemia or hyperglycemia, whereas increases ranging from 10% to 50% were associated with 2-5-fold increased odds of hyperglycemia. For patients with home insulin TDD ≥0.4units/kg/day, a weight-based dose of 0.4-0.6units/kg/day was associated with significantly higher odds of normoglycemia on HD2 (OR 3.99; 95% CI 1.42-11.21) compared to lower doses.


CONCLUSIONS
Compared to less aggressive increases, home insulin dose increases ranging from 10% to 50% were associated with greater odds of hyperglycemia without increased odds of hypoglycemia during early hospitalization. Weight-based insulin dosing may be a preferred strategy for glycemic control among patients whose home TDD is ≥0.4units/kg/day.
Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, United States.
Saira
S
Khan
Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, United States.
Sherita Hill
SH
Golden
Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, United States. Electronic address: nmathio1@jhmi.edu.
Nestoras
N
Mathioudakis
D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006699:Home Care Services / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
Basal; Glucose; Hospitalization; Hyperglycemia; Hypoglycemia; Insulin