Waiting to deliver insulin until the patient has eaten at least half of their meal reduced hypoglycemia without raising severe hyperglycemia.
In a single-center study, shifting the timing of nutritional insulin from pre- to post-prandial reduced the risk for hypoglycemia without affecting rates of severe hyperglycemia or hospital length of stay.The retrospective study performed at a community hospital evaluated adult inpatients receiving nutritional insulin.
On June 28, 2019, hospital policy changed the timing of nutritional insulin from preprandial to administration after at least 50% of the meal was consumed. Analysis stratified by three time periods: Preintervention, September 2018 to June 27, 2019; immediate postintervention, July 2019 to February 2020; and distant postintervention, September 2022 to August 2023).
Outcomes included rates of hypoglycemia , moderate hypoglycemia , severe hypoglycemia , severe hyperglycemia , daily mean glucose, and length of stay . The number of patient-days analyzed for timepoints 1, 2, and 3 were 1948, 1751, and 3244 patient-days, respectively.Unadjusted rates of any hypoglycemia were significantly reduced across the three time periods, from 9.4% to 8.9% to 6.7% , but not between timepoints 1 and 2.=.24), while there was a nonsignificant trend toward lower severe hypoglycemia rates , although mean daily glucose did significantly increase over time , but not between 1 and 2.
Hospitals Hyperglycemia Inpatient Care Inpatient Hemoglobin A1c Hemoglobin A1c Test Glycated Hemoglobin Glycosylated Hemoglobin Hba1c A1C Hb1c Glycohemoglobin Ghb Diabetic Control Index A1C Assay
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