Sliding scale insulin (SSI) continues to be widely used for glycemic management of inpatients with T2D despite condemnation in clinical guidelines. To confirm the accuracy of this clinical guideline recommendation, we determined the efficacy and safety of using SSI for the management hyperglycemia of non-critical patients with T2D in a large multinational, propensity-matched cohort study. A total of 53,516 patients with ICD 9/10 code of T2D were included in the dataset. Patients were categorized as having received SSI only vs. basal insulin, and were matched according to age, BMI, Charlson Comorbidity Index, and admission blood glucose (BG). Among patients with admission BG <180 mg/dL treated with SSI, 69% achieved and maintained good glycemic control (mean hospital BG <180 mg/dl), compared to 52% of patients treated with basal insulin (p <.001). Patients treated with basal insulin had higher rates of hypoglycemia than patients treated with SSI (30 vs. 16%, p <.001). There were no differences in rates of lactic acidosis, acute MI, pneumonia, or bacteremia (p=NS). A total of 14.93% of patients initially treated with SSI alone failed to achieve adequate glycemic control and were started on basal insulin during the hospital stay. Those who failed SSI had significantly higher admission BG (227.4±90 vs. 175.8±71 mg/dl), greater rates of CKD (31 vs. 24%), CHF (29 vs. 24%), CAD (35 vs. 31%), and higher Charlson score (4.3±2.7 vs. 3.8±2.7) than patients who remained well controlled on SSI alone (all, p<.001).

Conclusion: In a multicenter, international, propensity-matched cohort study, 69% of patients with T2D with admission BG <180 mg/dL treated with SSI achieved good glycemic control. Patients admitted with higher BG and greater comorbidities are more likely to fail treatment with SSI alone. These data suggest that SSI may be appropriate for patients with mild/moderate hyperglycemia, thus simplifying recommendations for inpatient glycemic management.

Disclosure

A. Migdal: None. C. Fortin: None. Y. Guo: None. I. Hochberg: None. M.F. Magee: Consultant; Self; Mytonomy. Employee; Spouse/Partner; U.S. Food and Drug Administration. Research Support; Self; AstraZeneca, Eli Lilly and Company, National Institute of Diabetes and Digestive and Kidney Diseases. Speaker’s Bureau; Self; American Diabetes Association, Pri-Med LLC. Other Relationship; Self; Endocrine Society. F.J. Pasquel: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. Research Support; Self; Dexcom, Inc., Merck Sharp & Dohme Corp., National Institutes of Health. G.E. Umpierrez: None.

Funding

Jacobs Research Foundation

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