Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA.
Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA; Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, 6225 Smith Ave., Suite B-300, Baltimore, MD 21209, USA; Suburban Hospital, Johns Hopkins Medicine, 8600 Old Georgetown Road, Bethesda, MD 20814, USA.
Diabetes Res Clin Pract. 2024 Aug;214:111785. doi: 10.1016/j.diabres.2024.111785. Epub 2024 Jul 15.
Hospitalized patients can have inconsistent nutritional intake due to acute illness, changing diet, or unpredictable meal delivery. The aim of this study was to evaluate whether implementation of a hospital-wide policy shifting nutritional insulin administration from pre-meal to post-meal was associated with changes in glycemic control or length of stay (LOS).
This retrospective study performed at a community hospital evaluated adult inpatients receiving nutritional insulin across three time periods. pre-intervention, immediate post-intervention, and distant post-intervention. Outcomes included rates of hypoglycemia (glucose ≤ 70 mg/dL), moderate hypoglycemia (< 54 mg/dL), severe hypoglycemia (≤ 40 mg/dL), severe hyperglycemia (≥ 300 mg/dL), daily mean glucose level, and LOS.
The number of patient-days analyzed across the cohorts were 1948, 1751, and 3244, respectively. After multivariate adjustment, risk of developing any hypoglycemia and severe hypoglycemia significantly decreased over time (p = 0.001 and p = 0.009, respectively). Daily mean glucose increased over time (194.6 ± 62.5 vs 196.8 ± 65.5 vs 199.3 ± 61.5 mg/dL; p = 0.003), but there were no significant differences among rates of severe hyperglycemia (p = 0.10) or LOS (p = 0.74).
Implementing a hospital-wide shift to postprandial nutritional insulin administration significantly reduced hypoglycemia rates without increasing severe hyperglycemia. This suggests a promising strategy for improving patient safety, but further prospective randomized controlled trials are warranted to confirm these findings.
由于急性疾病、饮食变化或不可预测的送餐，住院患者的营养摄入可能不一致。本研究旨在评估在全院范围内将营养胰岛素给药从餐前改为餐后，是否与血糖控制或住院时间（LOS）的变化相关。
这项在社区医院进行的回顾性研究评估了三个时间段内接受营养胰岛素治疗的成年住院患者。分别为干预前、干预即刻后和干预后远期。主要结局包括低血糖（血糖≤70mg/dL）、中度低血糖（<54mg/dL）、重度低血糖（≤40mg/dL）、重度高血糖（≥300mg/dL）、每日平均血糖水平和 LOS 的发生率。
三个队列的患者天数分析分别为 1948、1751 和 3244。经过多变量调整后，随着时间的推移，发生任何低血糖和重度低血糖的风险显著降低（p=0.001 和 p=0.009）。每日平均血糖水平随时间升高（194.6±62.5 vs 196.8±65.5 vs 199.3±61.5mg/dL；p=0.003），但重度高血糖发生率（p=0.10）和 LOS 无显著差异（p=0.74）。
在全院范围内实施餐后营养胰岛素给药的转变显著降低了低血糖发生率，而不会增加重度高血糖的发生。这表明这是一种改善患者安全性的有前途的策略，但需要进一步进行前瞻性随机对照试验来证实这些发现。
