Hyperglycemia is a common complication in hospitalized patients with type 2 diabetes mellitus (T2DM) on continuous enteral nutrition therapy (ENT). The purpose of this study was to identify an insulin regimen for this patient population that provided adequate coverage for hyperglycemia without significant hypoglycemia. A retrospective chart review was conducted at the University of Vermont Medical Center for noncritically ill patients admitted between 07/01/2012 and 09/01/2015 who had T2DM and received continuous ENT for ≥72 hours—209 patients met the inclusion criteria; 117 had received aspart sliding scale only and 92 had received aspart with long-acting glargine. Our results revealed no evidence of severe hypoglycemia (blood glucose <40mg/dL) in either group, and the occurrence of hypoglycemia (blood glucose <70mg/dL) was similar in both groups (p=0.54). However, there was a difference in the percentage of blood glucose values within the optimal range (100 to 180mg/dL): the aspart-only group had 60.3%±27.2% of values within this range compared to 36.6%±24.4% in the aspart+glargine group (p<0.001). The aspart+glargine group had blood glucose levels >180 mg/dL 58.8%±26.9%of the time compared to 33.1%±28.6% in the aspart-only group (p<0.0001).
In conclusion, both insulin regimens resulted in similar efficacy in noncritically ill, hospitalized patients with T2DM receiving continuous ENT without significant hypoglycemia. However, neither regimen resulted in blood glucose values in the optimal range for a sufficient percentage of the 72-hour period. A basal and bolus insulin regimen, rather than sliding scale only, is likely needed to improve overall glycemic control in these patients while preventing hypoglycemia. Further prospective studies are needed in this area to identify the most appropriate insulin program to treat hyperglycemia in hospitalized patients on ENT.
D.J. Selen: Employee; Spouse/Partner; CVS/Caremark. A.B. Howard: None. M.P. Gilbert: Consultant; Self; Sanofi US, Novo Nordisk A/S.