846-P: Basal Insulin Management in Inpatients Who Are Not Eating: Is There a Difference between Medical and Surgical Patients?

Abstract

Background: Guidelines from the 2021 American Diabetes Association recommend basal or basal plus correctional insulin dosing for non-critically ill hospitalized patients with poor oral intake or are nil per os (NPO). The recommended adjustment is 75-80% of long-acting basal insulin administered perioperatively. The aim of this study was to build on the current data available to determine the optimal management of insulin detemir dosing between medicine and surgery patients who were unable to eat. Methods: This was a retrospective single-center observational study between January and December 2019 that included patients with type 2 diabetes and confirmed NPO status receiving insulin detemir. To determine best practices of long-acting insulin management, 100%, 80-33%, and 0% insulin detemir dosing in medical and surgical patients were evaluated. The primary endpoint was incidence of hypoglycemia (<70 mg/dL) after insulin dose adjustment. Secondary endpoints were incidence of severe hypoglycemia (<40 mg/dL) and hyperglycemia (>180 mg/dL) after insulin dose adjustment. Results: Of the 100 adult patients who met the criteria, there were no incidences of hypoglycemia or severe hypoglycemia regardless of insulin detemir dose adjustment in either medical or surgical patients. In the medicine group, hyperglycemia occurred in 23/67 (34.3%), 2/6 (33.3%), 4/12 (33.3%) for 100%, 80-33%, and 0% insulin dose adjustments, respectively. In the surgery group, hyperglycemia occurred in 8/12 (66.7%) in patients receiving 100% insulin detemir dosage with no notable outcomes in the remaining 3 patients. Conclusions: There was no incidence of hypoglycemia or severe hypoglycemia between medical and surgical patients, regardless of insulin detemir dose adjustment. A numerically higher incidence of hyperglycemia was observed in patients receiving 100% insulin detemir in both medicine and surgery patients. Further education is planned to reduce hyperglycemia. Disclosure J. Sacdal: None. H. A. Habib: None. E. Cheon: None. E. Oh: None.