1075-P: Evaluating the Safety of Basal Insulin for the Management of Type 2 Diabetes in the Emergency Room Setting

Background: Evidenced based guidelines for hyperglycemia management in the emergency room (ED) are lacking. Basal plus bolus with correction insulins are the preferred treatment in noncritically ill hyperglycemic inpatients. We aimed to study if basal plus correction insulins can be safely and effectively initiated earlier in the hospitalization course in the ED.

Methods: Inclusion criteria: triage glucose >300 mg/dL, age > 18, type 2 diabetes (T2D), boarded for admission. Exclusion criteria: DKA, HHS, critically ill or simultaneous cirrhosis with pancreatitis. 23 patients received basal plus correction insulins according to the intervention. 259 patients received standard therapy. Intervention: The lower of glargine 0.1U/kg or 10 U was administered if the last dose of basal insulin was > 24 hours ago. A lispro correction of 2 U was administered every 6 hours if the last dose of basal was <24 hours ago or if the glucoses remained >300 mg/dL. Outcomes: Time to target glucose was defined as time from triage to two successive glucose values < 300 mg/dl at least 4 hours apart. Hypoglycemia was defined as glucose < 80 mg/dl.

Results: The control group comprised of 53% males, 47% females, 40% black and 42% who identified as Hispanic/Latino with an average age of 61.2, GFR 55.8, A1c 11.2% and mean BMI of 26.9. The intervention group comprised of 42% males, 58% females,48% black and 48% who identified as Hispanic/Latino with an average age of 65.4, GFR 48.2, A1c 11.5% and a mean BMI of 25.62. Time to target glucose was 23.3 hours in the intervention vs 21.6 hours in the control group. No hypoglycemia occurred in the intervention group; however, the incidence of hypoglycemia was 12.7% in the control group.

Conclusion: Basal plus correction insulins can be safely initiated, in the ED with less hypoglycemia, in noncritically ill T2D patients boarded for admission.