Guidelines recommend discontinuing oral antidiabetes drugs (OADs) on admission and initiating basal bolus insulin therapy. In the real world, concurrent OAD use with insulin is common and may affect outcomes. We conducted a large, retrospective study of 4558 patients age >18, admission >48 hours, and administered insulin >75% of days. 847 (18.58%) were administered OADs along with insulin within the first 2 days. Insulin therapy was categorized into 3 groups based on observed prescribing practices: sliding scale (SS), basal and scheduled rapid acting bolus (BB), Basal and rapid acting as needed (B+). Each group was analyzed for glucose control by days with hypoglycemia (any <70 mg/dl), hyperglycemia (mean >180 mg/dl) or euglycemia (no hypo- or hyperglycemia). Clinical outcomes included length of stay, 30/60 day readmission, and hospital mortality. Previously identified patient and provider factors that influence the choice of therapy were controlled using propensity score adjusted models. There were no statistical significant differences in hyperglycemia, euglycemia or clinical outcomes between BB or B+ compared to SS. However, hypoglycemia occurred 2 times more in BB compared to SS. B+ also had a higher trend of hypoglycemia. In our hospital system, basal insulin along with OADs resulted in more hypoglycemia. Further investigation is needed on optimizing these choices of therapy.
B. Patham: None. S. Chikermane: None. A. Vadhariya: None. M.L. Johnson: None. A.R. Sadhu: None.
