Petite Sarah E, Huenecke Joseph, Tuttle Natalie
The University of Toledo, OH, USA.
Vanderbilt University Medical Center, Nashville, TN, USA.
Hosp Pharm. 2020 Aug;55(4):246-252. doi: 10.1177/0018578719841029. Epub 2019 Apr 8.
The American Diabetes Association guidelines recommend a basal plus correction or basal insulin regimen for patients with type 2 diabetes mellitus (T2DM) receiving nothing by mouth (NPO; nil per os) in the non-intensive care unit setting. In the perioperative setting, 60% to 80% of long-acting insulin or half-dose morning insulin NPH is recommended. The goal of this study was to determine the impact of basal insulin dose reduction for hospitalized patients with insulin-dependent T2DM while NPO. This retrospective, single-center study evaluated patients admitted to the non-intensive care unit setting. Administration of >50% of home basal insulin was compared with administration of ≤50% of home basal insulin. The primary outcome was the difference in hypoglycemic events (blood glucose [BG] < 70 mg/dL). Secondary outcomes included comparing severe hypoglycemic events (BG < 40 mg/dL), hyperglycemic events (BG > 180 mg/dL), and hospital length of stay (LOS). Two hundred fifty-eight patient encounters were included, of which 85 and 173 patients received ≤50% and >50% of their home basal insulin dose, respectively. There were no significant differences in hypoglycemia (21.2% vs 21.4%; = .97), severe hypoglycemia (1.2% vs 2.9%; = .67), and hospital LOS (3 [IQR 2.13-6.74] days vs 4.66 [IQR 2.94-8.17] days; = .74). Hyperglycemia occurred at a higher rate in patients receiving ≤50% of their home basal insulin dose (97.6% vs 89%; = .02). No differences were observed in hypoglycemic events between those patients receiving ≤50% and >50% of their home basal insulin.
美国糖尿病协会指南建议，在非重症监护病房环境中，对于接受禁食（NPO；无经口摄入）的2型糖尿病（T2DM）患者，采用基础胰岛素联合校正剂量或基础胰岛素治疗方案。在围手术期，建议使用60%至80%的长效胰岛素或一半剂量的早晨中性鱼精蛋白锌胰岛素。本研究的目的是确定禁食期间胰岛素依赖型T2DM住院患者基础胰岛素剂量减少的影响。这项回顾性单中心研究评估了入住非重症监护病房的患者。将给予超过50%的家庭基础胰岛素与给予≤50%的家庭基础胰岛素进行比较。主要结局是低血糖事件（血糖[BG]<70mg/dL）的差异。次要结局包括比较严重低血糖事件（BG<40mg/dL）、高血糖事件（BG>180mg/dL）和住院时间（LOS）。纳入了258例患者，其中85例和173例患者分别接受了≤50%和>50%的家庭基础胰岛素剂量。低血糖（21.2%对21.4%；P = 0.97）、严重低血糖（1.2%对2.9%；P = 0.67）和住院LOS（3[四分位间距2.13 - 6.74]天对4.66[四分位间距2.94 - 8.17]天；P = 0.74）方面无显著差异。接受≤50%家庭基础胰岛素剂量的患者高血糖发生率更高（97.6%对89%；P = 0.02）。接受≤50%和>50%家庭基础胰岛素的患者在低血糖事件方面未观察到差异。
