1234-P: Utility of Sliding Scale Insulin on Inpatient Glycemic Care of Type 2 Diabetes Mellitus

Abstract

Background: According to the American Diabetes Association (ADA), sliding scale insulin (SSI) monotherapy as inpatient diabetes management is strongly discouraged. The focus of our study is to determine the use of SSI on patients with type 2 diabetes mellitus (T2DM) on oral agents admitted to the general medical floor in a community hospital. Methodology: A chart review was performed on patients with T2DM on oral agents admitted as an inpatient to our community hospital, from July 1, 2018 to July 1, 2019, that had SSI ordered. Patients were excluded if they were admitted to the ICU or had surgical intervention. Diabetes management was determined which can include additional basal and prandial insulin or continuation of home oral medication. Other data obtained included demographics, blood glucose levels, hypoglycemia (<70 mg/dl), recent hemoglobin A1c level (HbA1c), and length of hospital stay. Results: After 242 patient charts were reviewed, a total of 105 patients met exclusion criteria. In the 137 included patients, the mean age was 72.4 years, mean HbA1c level of 7.5%, and 55.4% were men. The mean length of hospital stay was 5.9 days. Most of the patients received SSI alone (n=108, 78.8%) followed by SSI with home oral medications (n=27, 19.7%), and lastly SSI with basal insulin (n=2, 1.5%). Mean blood glucose level was elevated in patients who had SSI with basal insulin (193.5mg/dL) and SSI alone (182.8mg/dL). On all included patients, six had hypoglycemia and all of them received SSI alone. Of the two patients who received basal insulin, they were provided with less basal insulin dose compared to weight-based calculation. Conclusion: SSI is commonly used as monotherapy for inpatient diabetes management despite having recommendations against its use. SSI monotherapy is associated with increased rates of hypoglycemia episodes and poor glycemic control. Quality improvement interventions will be initiated among providers with regard to the appropriate inpatient diabetic care to improve patient care. Disclosure K.A. Arao: None. F.N. Ebadi: None. M.M. Capistrano: None. K.K. Chen: None.