Prospective cohort study finds worse in-hospital glycemic control with sliding scale insulin in type 2 diabetes, suggesting fixed-dose regimens provide superior clinical utility.
Objectives: To assess the effect of sliding scale insulin (SSI) use on glycemic control and length of hospital stay in patients with diabetes mellitus. Methods: A prospective cohort study of 182 patients with diabetes mellitus as a primary diagnosis or a comorbid condition admitted consecutively to the internal medicine wards over a 6-week period. Demographic, clinical and laboratory data were collected from in-patient medical records. Data were analyzed using Chi-square and independent t-tests and presented as the mean ± standard error of the mean. Results: Of the total 182 in-patients with Type 2 diabetes, 130 (71.4%) were placed on SSI (Group A) and 52 (28.6%) on standing-dose antihyperglycemic therapy without the use of SSI (Group B). While there was no difference in admission blood glucose values (mg/dl) between Group A (236 ± 14.3) and Group B (237 ± 6.4), higher average in-hospital fasting blood glucose values were recorded from Group A (168 ± 7.2) compared with Group B (139 ± 11.5), p = 0.04. Plasma glucose values at discharge were not significantly different between the two groups with an average of 172 ± 8.1 for Group A and 170 ± 18.1 for Group B. Also, there was no significant difference in the number of days of hospitalization between the two groups with an average of (7.6 ± 0.89) for Group A and (10 ± 4.7) for Group B. Conclusion: SSI use is associated with higher in-hospital blood glucose and does not offer any advantage in terms of duration of hospital stay as compared with standard-dose antihyperglycemic therapy.
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McFarlane et al. (2004) studied this question.
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