TY - JOUR
T1 - Sliding Scale Insulin vs Basal-Bolus Insulin Therapy in Long-Term Care
T2 - A 21-Day Randomized Controlled Trial Comparing Efficacy, Safety and Feasibility
AU - Dharmarajan, Thiruvinvamalai S.
AU - Mahajan, Dheeraj
AU - Zambrano, Annie
AU - Agarwal, Bikash
AU - Fischer, Rachel
AU - Sheikh, Zahra
AU - Skokowska-Lebelt, Anna
AU - Patel, Meenakshi
AU - Wester, Rebecca
AU - Madireddy, Naga P.
AU - Pandya, Naushira
AU - Baralatei, Florence T.
AU - Vance, Jackie
AU - Norkus, Edward P.
N1 - Funding Information:
Study was sponsored by the AMDA Foundation, supported by a grant from Sanofi (LANTU_R_05927).
Publisher Copyright:
© 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Introduction: Sliding scale insulin (SSI) therapy remains a common means of insulin therapy in long-term care (LTC) for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Lack of randomized trial data on the efficacy and safety of basal-bolus insulin (B-BI) therapy in nursing home residents may have precluded this form of insulin administration in the LTC setting. Our study is a comparison of the efficacy of SSI (control) and B-BI (intervention) therapies during a 21-day intervention trial in older nursing home residents. Methods: Fourteen LTC facilities in the US participated; 110 residents with type 2 diabetes volunteered to participate; 35 failed inclusion criteria, 75 signed informed written consent, and 11 were discharged to home/hospital or withdrew consent; data from 64 participants are reported. Recent fasting blood glucose (FBG), hemoglobin A1c, and chemistries were obtained. Four glucose readings (prior to breakfast, lunch, dinner, and bedtime), oral antiglycemic drug, and insulin doses and changes, and all adverse events/serious adverse events, both those related to glucose control [hypoglycemic (<70 mg/dL) and hyperglycemic (>200 mg/dL) episodes] and those unrelated, were recorded daily. Patients were randomized to either remain on SSI or be shifted to the B-BI group. Results: Nursing home residents 80 ± 8 (standard deviation) years, 66% female participated; Control and Intervention participants had similar age, gender, race distributions, comorbidity, and 3-day average pretrial FBG levels (all P > .05). At study end, B-BI volunteers had significantly lower 3-day average FBG levels vs pretrial (P = .0231) while SSI participants had no change in 3-day average FBG (P > .05). During the trial, participants from both groups had similar rates of hypoglycemia, hyperglycemia, other adverse events, and hospitalizations (serious adverse events) unrelated to glucose control (all P > .05). Conclusions: B-BI therapy produced significantly lower average FBG levels after 21 days compared with SSI therapy; both groups had similar rates of hypo- and hyperglycemia. Switching to B-BI therapy is feasible, safe, and effective in the LTC setting.
AB - Introduction: Sliding scale insulin (SSI) therapy remains a common means of insulin therapy in long-term care (LTC) for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Lack of randomized trial data on the efficacy and safety of basal-bolus insulin (B-BI) therapy in nursing home residents may have precluded this form of insulin administration in the LTC setting. Our study is a comparison of the efficacy of SSI (control) and B-BI (intervention) therapies during a 21-day intervention trial in older nursing home residents. Methods: Fourteen LTC facilities in the US participated; 110 residents with type 2 diabetes volunteered to participate; 35 failed inclusion criteria, 75 signed informed written consent, and 11 were discharged to home/hospital or withdrew consent; data from 64 participants are reported. Recent fasting blood glucose (FBG), hemoglobin A1c, and chemistries were obtained. Four glucose readings (prior to breakfast, lunch, dinner, and bedtime), oral antiglycemic drug, and insulin doses and changes, and all adverse events/serious adverse events, both those related to glucose control [hypoglycemic (<70 mg/dL) and hyperglycemic (>200 mg/dL) episodes] and those unrelated, were recorded daily. Patients were randomized to either remain on SSI or be shifted to the B-BI group. Results: Nursing home residents 80 ± 8 (standard deviation) years, 66% female participated; Control and Intervention participants had similar age, gender, race distributions, comorbidity, and 3-day average pretrial FBG levels (all P > .05). At study end, B-BI volunteers had significantly lower 3-day average FBG levels vs pretrial (P = .0231) while SSI participants had no change in 3-day average FBG (P > .05). During the trial, participants from both groups had similar rates of hypoglycemia, hyperglycemia, other adverse events, and hospitalizations (serious adverse events) unrelated to glucose control (all P > .05). Conclusions: B-BI therapy produced significantly lower average FBG levels after 21 days compared with SSI therapy; both groups had similar rates of hypo- and hyperglycemia. Switching to B-BI therapy is feasible, safe, and effective in the LTC setting.
KW - Basal-bolus insulin therapy
KW - Efficacy and safety of basal-bolus insulin therapy in long-term care
KW - Insulin therapy for type 2 diabetes in long term care
KW - Sliding scale insulin therapy
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U2 - 10.1016/j.jamda.2015.08.015
DO - 10.1016/j.jamda.2015.08.015
M3 - Article
C2 - 26432623
AN - SCOPUS:84958917042
SN - 1525-8610
VL - 17
SP - 206
EP - 213
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 3
ER -
