Switching from insulin degludec (iDeg) to another basal insulin is often needed upon admission. No study has reported glycemic data or how clinicians switch patients from iDeg to insulin glargine (iG100) during the acute transition period. We present the first real-world study of transitioning from iDeg to iG100 when patients with T1D or T2D are admitted to the hospital.
This is a retrospective chart review of 244 admissions to a tertiary care center between 2/1/16-10/31/19 to identify patients with T1D and T2D transitioning from iDeg to iG100 inpatient by hospitalists and surgeons. Inclusion criteria: using iDeg ≥ the 4 days prior to admission; documentation of the home dose of iDeg; and having ≥ 24 hours of BG data from the time of admission. Exclusion criteria: not using iDeg consistently within 4 days prior to admission; inability to verify home dose of iDeg; BG >250mg/dL on admission; and using corticosteroids or IV insulin within 4 days of admission. Thirty-one patients with T2D and 7 patients with T1D had analyses performed on their BG values, home iDeg doses, and inpatient iG100 doses between day 1-4 of the admission.
Clinicians gave iG100 at 0-100% of home iDeg dose anytime between 24-72 hours after the last iDeg dose. Patients with T2D used a median of 30U of iDeg at home (range 8-100U) and had a median/SD BG of 170 ± 40mg/dL. No patient with T2D had a BG<70mg/dL, 48% had BG of 250-300mg/dL, and 16% had BG>300mg/dL. Patients with T1D used a median of 13U of iDeg at home (range 3-55U) and had a median/SD BG of 177 ± 53mg/dL. Two patients of T1D had BG<70mg/dL, 86% had BG of 250-300mg/dL, 71% had a BG >300mg/dL, and 0% developed DKA during the transition.
Despite clinicians ordering arbitrary doses and timing of iG100 for this transition, patients with T2D maintained their BG in a safe range, but patients with T1D developed more glycemic variability with hypo- and overt hyperglycemia. Using evidence and knowledge of iDeg’s PK and PD, developing consensus guidelines emphasizing safety of patients with T1D undergoing iDeg to iG100 transition is possible.
J. Chao: None. I.B. Hirsch: Consultant; Self; Abbott, Bigfoot Biomedical, Roche Diabetes Care. Research Support; Self; Medtronic, Omnipod.