Abstract
Background: Basal-bolus insulin is the standard of care to treat hyperglycemia in hospitalized patients in the non-ICU setting. Matching insulin with food is a barrier to achieving blood glucose (BG) goals. The glycemic impact of a snack at bedtime without prandial insulin and delayed meal-time bolus in the hospital has not been previously explored. Methods: The InFi study is an ongoing randomized controlled open-label trial comparing Fiasp vs aspart in hospitalized patients using the Dexcom G6 PRO CGM to assess postmeal glycemic outcomes. We performed an interim analysis of 100 subjects to assess the impact of bedtime snacks on fasting POC glucose (FG) and the impact of delayed meal bolus on postprandial sensor glucose (PPSG) time in range (TIR) 70-180 mg/dL. Meal intake was determined by a CGM heuristic, insulin bolus time by barcoded EMR. Results: Four hour post-meal TIR was 54% for on-time boluses (n=119) vs 25% with bolus delay of >5 minutes (n=86), p <0.001. Evening snacking (9pm-12am) was associated with higher FG levels, 201 vs 158 mg/dL (N=30, 50), p = 0.03. Conclusion: Delayed meal-time insulin bolusing is common in hospitalized patients and results in a significant reduction in post-meal TIR. Evening snacking is a significant cause of overnight hyperglycemia. Given the importance of BG control, hospitals should work to optimize meal insulin delivery and develop strategies to address bedtime food intake. Disclosure S.Alexanian: Research Support; Novo Nordisk. M.C.Cheney: None. J.Bello ramos: None. N.L.Spartano: Research Support; Novo Nordisk. H.Wolpert: Consultant; Abbott Diabetes, Employee; Eli Lilly and Company. D.W.Steenkamp: Research Support; Abbott Diabetes, Novo Nordisk. Funding Novo Nordisk (ISS-001295)
Published Version
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