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Effects of preprandial versus postprandial nutritional insulin administration in the inpatient setting. | LitMetric

Effects of preprandial versus postprandial nutritional insulin administration in the inpatient setting.

Diabetes Res Clin Pract

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; Johns Hopkins Howard County Medical Center, Johns Hopkins Medicine, 5755 Cedar Ln, Columbia, MD 20794, USA. Electronic address:

Published: August 2024

AI Article Synopsis

Article Abstract

Aims: 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).

Methods: 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.

Results: 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).

Conclusions: 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.

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Source
http://dx.doi.org/10.1016/j.diabres.2024.111785DOI Listing

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