Journal Article

Insulin Therapy and Glycemic Control in Hospitalized Patients With Diabetes During Enteral Nutrition Therapy

Kenneth K.W. Lee, Almoatazbellah M. Idriss, Frederico G.S. Toledo, Esra Karslioglu, Faith Selzer, Rose J. Salata, Mary T. Korytkowski, A. James Moser, Glory L. Koerbel

2009

Overview

Insulin Therapy and Glycemic Control in Hospitalized Patients With Diabetes During Enteral Nutrition Therapy A randomized controlled clinical trial Mary T. Korytkowski , MD , 1 , Rose J. Salata , MD 1 , Glory L. Koerbel , RN, MSN 1 , Faith Selzer , PHD 2 , Esra Karslioglu , MD 1 , Almoatazbellah M. Idriss , MD 1 , Kenneth K.W. Lee , MD 3 , A. James Moser , MD 3 and Frederico G.S. Toledo , MD 1 1 Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; 2 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; 3 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Corresponding author: Mary T. Korytkowski, korytkowski{at}dom.pitt.edu . Abstract OBJECTIVE To compare two subcutaneous insulin strategies for glycemic management of hyperglycemia in non–critically ill hospitalized patients with diabetes during enteral nutrition therapy (ENT). RESEARCH DESIGN AND METHODS Fifty inpatients were prospectively randomized to receive sliding-scale regular insulin (SSRI) alone ( n = 25) or in combination with insulin glargine ( n = 25). NPH insulin was added for persistent hyperglycemia in the SSRI group (glucose >10 mmol/l). RESULTS Glycemic control was similar in the SSRI and glargine groups (mean ± SD study glucose 8.9 ± 1.6 vs. 9.2 ± 1.6 mmol/l, respectively; P = 0.71). NPH insulin was added in 48% of the SSRI group subjects. There were no group differences in frequency of hypoglycemia (1.3 ± 4.1 vs. 1.1 ± 1.8%; P = 0.35), total adverse events, or length of stay. CONCLUSIONS Both insulin strategies (SSRI with the addition of NPH for persistent hyperglycemia and glargine) demonstrated similar efficacy and safety in non–critically ill hospitalized patients with type 2 diabetes during ENT. Footnotes The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received August 4, 2008. Accepted November 26, 2008. © 2009 by the American Diabetes Association.

• Publisher: American Diabetes Association