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DIABETES

Sliding Scale Versus Tight Glycemic Control in the Noncritically Ill at a Community Hospital

Clinical Pharmacy Coordinator, Pharmacy Department, Medical Center of Plano, Plano, TX

Nicki Roderman, MSN

Critical Care Clinical Nurse Specialist, Critical Care Unit, Medical Center of Plano

Karen A Lee, PharmD

Pharmacy Intern, Pharmacy Department, Medical Center of Plano

Melissa M Charles, PharmD

Pharmacy Intern, Pharmacy Department, Medical Center of Plano

Diem Nguyen, PharmD

Pharmacy Intern, Pharmacy Department, Medical Center of Plano

Paula Beougher, PharmD

Pharmacy Intern, Pharmacy Department, Medical Center of Plano

Kacie Kleja, MS

Analyst/Biostatistician, Clinical Services Group, Hospital Corporation of America, Nashville, TN

Evangelina Casteneda, MD

Chief Endocrinologist, Endocrinology Department, Medical Center of Plano

Reprints: Dr. Patel, Pharmacy Department, Medical Center of Plano, 3901 W. 15th St., Plano, TX 75075, fax 972/519-1239, Gita.patel{at}hcahealthcare.com

BACKGROUND: Development of hyperglycemia during hospitalization is an area of concern in patients with and without diabetes mellitus. Tight glycemic control has been debated for critically ill and noncritically ill patients with hyperglycemia. Although many studies have been performed in the critically ill, adequate data are not available in the noncritically ill population.

OBJECTIVE: To compare traditional sliding scale (SS) with a tight glycemic control (TC) algorithm. The primary endpoint was the percentage of total blood glucose measurements in the target range of 80–150 mg/dL. The secondary endpoint evaluated was safety, defined as percentage of all blood glucose measurements that were 0–60 mg/dL.

METHODS: A 1-year, retrospective analysis from June 1, 2007, to May 31, 2008, was performed evaluating all inpatients with hyperglycemia within the first 48 hours of admission to the Medical Center of Plano, Plano, TX. A cohort of patients managed with SS (n =121) was compared with those treated with TC (n = 210). Patients on SS insulin received a traditional SS regimen with regular insulin or insulin aspart based on physician preference.

RESULTS: Demographics and comorbidities were similar between the 2 groups; however, the TC cohort was younger (64.8 ± 14.1 vs 70.8 ± 13.7 y; p < 0.001). There were more persons with type 2 diabetes mellitus in the TC cohort (81.9%) versus the SS cohort (60.3%; p < 0.001). In the TC cohort, 42.9% of blood glucose measurements were in the target range of 80–150 mg/dL compared with 30.6% of the measurements in the SS cohort (p < 0.001). Regarding safety, 2% of blood glucose measurements of the TC cohort were in the range of 0–60 mg/dL versus 0.3% of the SS cohort (p < 0.001). No clinical sequelae of hypoglycemia were observed. Patients achieved more blood glucose measurements in the target range when treated with TC versus SS insulin, without regard to prior history of diabetes.

CONCLUSIONS: Patients treated with TC experienced more blood glucose measurements in the target range as compared with patients treated with SS with relatively low hypoglycemia rates.

Key Words: diabetes mellitus, insulin, noncritically ill, sliding scale

Published Online, October 13, 2009. www.theannals.com, DOI 10.1345/aph.1M331