Nurse-managed basal-bolus versus sliding-scale insulin regimen in subjects with hyperglycemia at admission for orthopedic surgery: a propensity score approach. | LitMetric
Department of Medical and Surgical Sciences (DIMEC), "Alma Mater" University, 9, Via Massarenti, 40138, Bologna, Italy.
Published: July 2020
AI Article Synopsis
Article Abstract
Aims: A sliding-scale (SS) regimen is discouraged to correct hyperglycemia in hospital patients, but there is resistance to adoption of basal-bolus (BB) treatment in surgical units. We tested the feasibility and the effects of a nurse-based BB regimen in orthopedic surgery.
Methods: Following an intense training to implement a protocol amenable by nurses, a group of patients admitted with hyperglycemia in an orthopedic institute were prospectively followed according to a basal-bolus insulin regimen (BB, n = 80). They were compared with a hyperglycemic group eventually treated by sliding-scale insulin on demand (SS, n = 122). Diabetes was present in 196 cases. Metabolic control was assessed during the first 3 days of surgery; outcome data were tested by logistic regression, after adjusting for propensity score.
Result: Average blood glucose and glucose variability were lower in BB versus SS (P < 0.001), in the presence of similar 3-day insulin doses. Complications were recorded in 68 cases (16.2% vs. 45.1% in BB and SS, respectively). BB regimen was associated with propensity-adjusted reduction in all adverse events [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17-0.76] and of systemic infections (OR 0.18; 95% CI 0.07-0.50) and with shorter hospital stay (8.8 ± SD 5.2 days vs. 12.5 ± 7.4; P < 0.01). The superiority of BB regimen was confirmed in the pair-matched analysis.
Conclusions: The study proves the feasibility and the superiority of nurse-based BB versus SS treatment in metabolic control and on the risk of adverse events in orthopedic surgery patients with hyperglycemia.
Hyperglycemia at admission is linked to complications and increased mortality, but strict glycemic control during hospitalization lacks strong evidence for benefits.
While strict control can reduce postoperative infections, it also raises the risk of hypoglycemia, which is a separate risk factor for mortality.
Switching from the ineffective sliding scale insulin regimen to a basal-bolus insulin approach may lead to better patient outcomes and lower workloads for healthcare providers.
The study aimed to assess how well outpatient diabetes management affects glycemic control in hospitalized patients.
Adult patients in a trauma intensive care unit were analyzed based on their diabetes status through metrics like hemoglobin A1c (Hgb A1c) and blood glucose levels.
Results showed that patients with uncontrolled diabetes required significantly more insulin and had less time within the target blood glucose range compared to those with controlled diabetes or no diabetes, indicating the need for early detection of uncontrolled diabetes for better management.
Objective: To evaluate the effects of medical education on hospital hyperglycemia on physician's technical knowledge and the quality of medical prescriptions, patient care, and clinical outcomes.
Subjects And Methods: The intervention included online classes and practical consultations provided by an endocrinologist to medical preceptors and residents of the Department of Internal Medicine. A pretest and a post-test (0 to 10 points) were applied before and after the intervention and patients medical records were reviewed before and after the intervention.
Hyperglycemia significantly affects critically ill COVID-19 patients, prompting a shift from continuous IV insulin to other management strategies during the pandemic.
A study of 120 mechanically ventilated ICU patients revealed that IV insulin infusions maintained blood glucose levels better (60% in target range) compared to sliding-scale (52%) and oral medications (12-29%).
The study recommends continuing IV insulin as the primary method for glycemic control, especially in patients also receiving corticosteroids, due to poorer management outcomes with those combinations.
Background: This retrospective study investigated the impact of continuing vs discontinuing home oral hypoglycemic medications for patients with diabetes undergoing total hip arthroplasty.
Materials And Methods: Patients who were not exclusively receiving home oral hypoglycemic regimens were excluded. Additionally, patients whose diabetes was not managed inpatient postoperatively were excluded.
