Evidence Generation for Postprandial Insulin Administration for Better Management of Diabetes in Noncritically iII Patients

Abstract

Introduction: Previously, premeal sliding scale insulin regimen was used to control sugar levels in hospitalized type-2 diabetes patients. However, the now recommended basal-bolus regimen also failed to show any substantial advantage over the traditional sliding scale regimen in the latest Cochrane review. Methodology: In this retrospective cohort study, data were collected from two groups of patients who received basal with premeal bolus regimen and those who received modified sliding scale regimen (basal with both pre- and lower dose postprandial insulin by sliding scale). The data collected were analyzed to compare the mean reduction in blood glucose level, number of hypoglycemic episodes, and mean hospital stay among the two groups. Results: A total of forty patients were included in the study. Twenty received basal with both pre- and postprandial insulin correction by sliding scale and other twenty received basal insulin with postmeal bolus correction regimen. The mean hospital stay in sliding scale with postprandial insulin correction was 3.9 ± 2.2 days, and in other group, it was 6.1 ± 4.47 days. Two out of twenty patients in the sliding scale with postprandial insulin group, whereas six out of twenty patients in the other group had hypoglycemic events. Conclusion: Basal with both pre- and postmeal (low dose) insulin by sliding scale might be an answer to the concerns of faster attainment of euglycemia in hospitalized type-2 diabetes patients with minimal risk of hypoglycemia. We plan a prospective study with a larger sample size to substantiate the evidence.