Efficacy of sliding-scale insulin therapy: a comparison with prospective regimens.

Objective: To compare the efficacy of retroactive sliding-scale insulin therapy, proactive therapy, and a combination of the two methods in establishing glycemic control in hospitalized diabetic patients.

Methods: Medical records of 47 diabetic ketoacidosis inpatients were reviewed retrospectively.

Results: The sliding-scale insulin therapy group's glucose deviation score (167.4) was significantly higher than the deviation for the proactive (112.9) and combination (121.3) groups. The sliding-scale insulin therapy group also had a significantly higher median glucose value (262.5) than the proactive (199.9) and combination (221.2) groups as well as a significantly higher number of nursing shifts (0.70) in which a glucose of 250 mg/dl or greater was recorded than in the proactive (0.37) and combination (0.40) groups. The proactive group was on their treatment regimen significantly less time than the combination group (5.5 vs 10.4 nursing shifts, respectively). The proactive group was hospitalized significantly fewer days (4.4) than the combination (6.3) and sliding-scale insulin therapy (6.3) groups.

Conclusions: The present study lends support to previous concerns that sliding-scale insulin therapy is less effective than preventive therapy in the management of hospitalized diabetic patients.