Abstract
The aim of this study was to characterize the variability of exogenous insulin requirements during fully closed-loop insulin delivery in hospitalized patients with type 2 diabetes or new-onset hyperglycaemia, and to determine patient-related characteristics associated with higher variability of insulin requirements. We retrospectively analysed data from two fully closed-loop inpatient studies involving adults with type 2 diabetes or new-onset hyperglycaemia requiring insulin therapy. The coefficient of variation quantified day-to-day variability of exogenous insulin requirements during up to 15 days using fully automated closed-loop insulin delivery. Data from 535 days in 67 participants were analysed. The coefficient of variation of day-to-day exogenous insulin requirements was 30% ± 16%, and was higher between nights than between any daytime period (56% ± 29% overnight [11:00 pm to 4:59 am] compared with 41% ± 21% in the morning [5:00 am to 10:59 am], 39% ± 15% in the afternoon [11:00 am to 4:59 pm] and 45% ± 19% during the evening [5:00 pm to 10:59 pm]; all P < 0.01). There is high day-to-day variability of exogenous insulin requirements in inpatients, particularly overnight, and diabetes management approaches should account for this variability.
Highlights
Safe and effective management of diabetes and stress-related hyperglycaemia in hospitalised patients can be challenging due to the impact of metabolic responses to acute illness, inconsistent oral intake and use of nutritional support, scheduled or unscheduled fasting periods, and medications affecting insulin sensitivity, for example corticosteroids [1, 2]
The variability of overnight exogenous insulin requirements in people with type 2 diabetes or new-onset hyperglycaemia in the inpatient setting in our study is even greater than the variability of overnight insulin requirements reported in adults with type 1 diabetes, 56% compared with 31% and 36%, [7, 8]
These results enhance our understanding of why attainment of recommended glucose targets during the hospital admission is challenging
Summary
Safe and effective management of diabetes and stress-related hyperglycaemia in hospitalised patients can be challenging due to the impact of metabolic responses to acute illness, inconsistent oral intake and use of nutritional support, scheduled or unscheduled fasting periods, and medications affecting insulin sensitivity, for example corticosteroids [1, 2]. Automated closed-loop insulin delivery systems can be used as a tool to provide an estimate of exogenous insulin requirements. Closed-loop systems incorporate an algorithm to modulate insulin delivery in response to real-time sensor glucose levels, reflecting the amount of insulin required to achieve in-hospital treatment targets. Closed-loop insulin delivery has been evaluated in inpatients with type 2 diabetes or new-onset hyperglycaemia in the non-critical care setting [3,4,5,6]. Randomised controlled trials comparing closed-loop insulin delivery with usual care on the general wards have demonstrated superior glycaemic control without increasing the risk of hypoglycaemia, even in patients requiring enteral/parenteral nutrition and haemodialysis [3,4,5,6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
