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sliding scale basal bolus

Rosalina Newsom, Christopher Patty, Emma Camarena, Regina Sawyer, Raymie McFarland, Thomas Gray, Melanie Mabrey
OBJECTIVE: Hyperglycemia is common in the inpatient setting and providers frequently rely on sliding scale insulin. This case study reviews the experience of one hospital moving from high utilization of sliding scale to basal bolus insulin therapy. METHOD: This Retrospective Quality Improvement Study describes the journey of clinicians at a 580-bed hospital to convert from high usage of SSI to BBI. Hyperglycemic adult patients prescribed insulin, with/without a diagnosis of diabetes, were included...
January 2018: Journal of Diabetes Science and Technology
Victoria L Phillips, Anwar L Byrd, Saira Adeel, Limin Peng, Dawn D Smiley, Guillermo E Umpierrez
BACKGROUND: The identification of cost-effective glycaemic management strategies is critical to hospitals. Treatment with a basal-bolus insulin (BBI) regimen has been shown to result in better glycaemic control and fewer complications than sliding scale regular insulin (SSI) in general surgery patients with type 2 diabetes mellitus (T2DM), but the effect on costs is unknown. OBJECTIVE: We conducted a post hoc analysis of the RABBIT Surgery trial to examine whether total inpatient costs per day for general surgery patients with T2DM treated with BBI ( n  = 103) differed from those for patients with T2DM treated with SSI ( n  = 99) regimens...
2017: PharmacoEconomics Open
Merete B Christensen, Anders Gotfredsen, Kirsten Nørgaard
Hyperglycemia during hospitalization is associated with increased rates of complications and longer hospital stays. Various insulin regimens are used in the inpatient diabetes management of non-critically ill patients. In this systematic review and meta-analysis, we aimed to assess the efficacy and safety of basal-bolus insulin therapy (BBI) by summarizing evidence from studies of BBI versus sliding scale insulin therapy (SSI) in the management of hospitalized non-critically ill type 2 diabetes patients. We searched MEDLINE, EMBASE, Scopus, and the Cochrane Library for studies comparing BBI therapy with SSI therapy in hospitalized non-critically ill patients with type 2 diabetes...
July 2017: Diabetes/metabolism Research and Reviews
Jeniece Trast Ilkowitz, Steven Choi, Michael L Rinke, Kathy Vandervoot, Rubina A Heptulla
BACKGROUND: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. METHODS: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families...
October 2016: Quality Management in Health Care
V Borzì, S Frasson, G Gussoni, M Di Lillo, R Gerloni, G Augello, G Gulli, A Ceriello, B Solerte, E Bonizzoni, A Fontanella
AIMS: Hypoglycemia is a potential risk in the management of patients suffering from type 2 diabetes (T2DM) and hospitalized in internal medicine units (IMUs). The aim of this analysis was to evaluate incidence of hypoglycemia and related risk factors in a group of patients admitted to IMUs. METHODS: We used the FADOI-DIAMOND study carried out in 53 Italian IMUs. The DIAMOND design included two cross-sectional surveys interspersed with an educational program. In both phases each center reviewed the charts of the last 30 hospitalized patients with known T2DM (n=3167), including information about hypoglycemia during hospital stay...
May 2016: Diabetes Research and Clinical Practice
Karam Choi, Tae Jung Oh, Jung Chan Lee, Myungjoon Kim, Hee Chan Kim, Young Min Cho, Sungwan Kim
Although various basal-bolus insulin therapy (BBIT) protocols have been used in the clinical environment, safer and more effective BBIT protocols are required for glucose control in hospitalized patients with type 2 diabetes (T2D). Modeling approaches could provide an evaluation environment for developing the optimal BBIT protocol prior to clinical trials at low cost and without risk of danger. In this study, an in-silico model was proposed to evaluate subcutaneous BBIT protocols in hospitalized patients with T2D...
February 2016: Journal of Korean Medical Science
Covadonga Gómez Cuervo, Ana Sánchez Morla, María Asunción Pérez-Jacoiste Asín, Otilia Bisbal Pardo, Luis Pérez Ordoño, Juan Vila Santos
INTRODUCTION: The aim of this review was to assess the effectiveness to reduce clinical adverse events and safety of insulin administered in basal-bolus-corrector or basal-corrector regimens (BB) versus a sliding scale scheme (SS) in patients with diabetes or newly diagnosed hyperglycemia admitted to a conventional (not critical) medical or surgical hospital ward. METHOD: A Medline search was conducted. The Odds ratio was the main summary measure. A random effects model with the Mantel-Haenszel procedure was used...
April 2016: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Thiruvinvamalai S Dharmarajan, Dheeraj Mahajan, Annie Zambrano, Bikash Agarwal, Rachel Fischer, Zahra Sheikh, Anna Skokowska-Lebelt, Meenakshi Patel, Rebecca Wester, Naga P Madireddy, Naushira Pandya, Florence T Baralatei, Jackie Vance, Edward P Norkus
INTRODUCTION: Sliding scale insulin (SSI) therapy remains a common means of insulin therapy in long-term care (LTC) for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Lack of randomized trial data on the efficacy and safety of basal-bolus insulin (B-BI) therapy in nursing home residents may have precluded this form of insulin administration in the LTC setting. Our study is a comparison of the efficacy of SSI (control) and B-BI (intervention) therapies during a 21-day intervention trial in older nursing home residents...
March 1, 2016: Journal of the American Medical Directors Association
Emily K Acton, Charles E Leonard, Mark H Schutta, Serena Cardillo, Andrea B Troxel, Rebecca Trotta, Sean Hennessy
BACKGROUND: To examine the feasibility of implementing clinician-supported inpatient self-managed insulin to aid in the planning of a randomized clinical trial. RESULTS: We conducted a proof-of-concept interventional study of inpatients with diabetes mellitus who had hospital orders for basal-bolus or sliding scale insulin. Patients meeting inclusion criteria were offered the opportunity to manage their own basal-bolus insulin with support from a diabetes nurse practitioner...
October 1, 2015: BMC Research Notes
Joshua D Valgardson, Maricruz Merino, Jamie Redgrave, James I Hudson, Margo S Hudson
OBJECTIVE: Recent guidelines recommend a physiologic approach to non-intensive care unit (ICU) inpatient glucose management utilizing basal-bolus with correctional (BBC) insulin over traditional sliding-scale insulin monotherapy. Unfortunately, few studies exist using a BBC approach restricted to human insulins (regular and neutral protamine Hagedorn [NPH]). This study evaluated changes in provider prescribing patterns, effects on blood glucose, and safety with implementation of hospital order sets for BBC using human insulins...
July 2015: Endocrine Practice
Daniel Sáenz-Abad, José Antonio Gimeno-Orna, Beatriz Sierra-Bergua, Juan Ignacio Pérez-Calvo
INTRODUCTION: This study was intended to assess the effectiveness and predictors factors of inpatient blood glucose control in diabetic patients admitted to medical departments. MATERIAL AND METHODS: A retrospective, analytical cohort study was conducted on patients discharged from internal medicine with a diagnosis related to diabetes. Variables collected included demographic characteristics, clinical data and laboratory parameters related to blood glucose control (HbA1c, basal plasma glucose, point-of-care capillary glucose)...
June 2015: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Kavita Singh, Mohammed T Ansari, Rakesh V Patel, Mario Bedard, Erin Keely, Mike Tierney, David Moher
PURPOSE: The comparative efficacy, safety, and cost-effectiveness of rapid and long-acting insulin analogs compared with regular or neutral protamine Hagedorn nonanalog insulins or with oral antidiabetic agents in hospitalized adults were evaluated. METHODS: A literature search was conducted to identify studies that compared the effects of rapid-acting, long-acting, or mixed insulin analogs with short- or intermediate-acting insulin or any other oral antidiabetic medication...
April 1, 2015: American Journal of Health-system Pharmacy: AJHP
Nandu Thalange, Larry Deeb, Violeta Iotova, Tomoyuki Kawamura, Georgeanna Klingensmith, Areti Philotheou, Janet Silverstein, Stefano Tumini, Ann-Marie Ocampo Francisco, Ona Kinduryte, Thomas Danne
Insulin degludec (IDeg) once-daily was compared with insulin detemir (IDet) once- or twice-daily, with prandial insulin aspart in a treat-to-target, randomized controlled trial in children 1-17 yr with type 1 diabetes, for 26 wk (n = 350), followed by a 26-wk extension (n = 280). Participants were randomized to receive either IDeg once daily at the same time each day or IDet given once or twice daily according to local labeling. Aspart was titrated according to a sliding scale or in accordance with an insulin:carbohydrate ratio and a plasma glucose correction factor...
May 2015: Pediatric Diabetes
Kalyan Kumar Gangopadhyay, Ganapathi Bantwal, Pradeep G Talwalkar, A Muruganathan, Ashok Kumar Das
Hyperglycaemia is an indicator of poor clinical outcome and mortality in patients with or without a history of diabetes in hospitalised patients in non-critical care condition. A consensus guideline has been developed by a panel of experts based on existing guidelines with specific attention to Indian clinical practice on the management of hyperglycaemia in patients admitted to non-critical care settings. Diagnosis for hyperglycaemia at the time of hospital admission is essential for appropriate treatment during the hospital stay and at the time of discharge...
July 2014: Journal of the Association of Physicians of India
María Asunción Martínez-Brocca, Cristóbal Morales, Pilar Rodríguez-Ortega, Beatriz González-Aguilera, Cristina Montes, Natalia Colomo, Gonzalo Piédrola, Mariola Méndez-Muros, Isabel Serrano, Maria Soledad Ruiz de Adana, Alberto Moreno, Ignacio Fernández, Manuel Aguilar, Domingo Acosta, Rafael Palomares
INTRODUCTION: In 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP). OBJECTIVE: To analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System. METHOD: A descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n=306) hospitalized for ≥48 hours in 5 non-surgical (SM) and 2 surgical (SQ) departments...
February 2015: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Hasniza Zaman Huri, Vishaaliny Permalu, Shireene Ratna Vethakkan
Sliding-scale and basal-bolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2 diabetes mellitus patients. Although its use is not recommended, sliding-scale insulin therapy is still being used widely. The aims of the study were to compare the glycemic control achieved by using sliding-scale or basal-bolus regimens for the management of severe or acute hyperglycemia in patients with type 2 diabetes and to analyze factors associated with the types of insulin therapy used in the management of severe or acute hyperglycemia...
2014: PloS One
Syed Tehseen Akhtar, Khalid Mahmood, Iftikhar Haider Naqvi, Aneel Sham Vaswani
OBJECTIVE: To assess inpatient management of non-critically ill type 2 diabetics with different insulin regimen. METHODS: We reviewed the medical records of all non-critically ill type 2 diabetic patients more than 18 years of age in medical department of civil hospital Karachi and Dow University of Health Sciences from January 2011 to December 2012. We collected the data from case records in data collection sheets that fulfill the inclusion criteria and divided the study subjects into three groups according to insulin regimen they received...
July 2014: Pakistan Journal of Medical Sciences Quarterly
Mary-Anne Doyle, Sharon Brez, Silvana Sicoli, Filomena De Sousa, Erin Keely, Janine C Malcom
OBJECTIVE: To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. METHODS: Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process...
April 2014: Canadian Journal of Diabetes
Edson Duarte Moreira, Patricia Carvalho Balthazar Silveira, Raimundo Celestino Silva Neves, Clodoaldo Souza, Zaira Onofre Nunes, Maria da Conceição C Almeida
BACKGROUND: The importance of tight blood glucose control among outpatients with diabetes mellitus is well established, however, the management of diabetes in the hospital setting is generally considered secondary in importance. This study sought to assess glycemic control and diabetes management in adult patients admitted to hospitals in Brazil. METHODS: A cross-sectional and nationwide survey was conducted from July 2010 to January 2012. Eligible cases were 18 years of age or older, had a diagnosis of diabetes and a hospitalization length of stay ≥72 hours...
2013: Diabetology & Metabolic Syndrome
Bridget Jackson, Laurie Grubbs
PURPOSE: To present an integrative review related to basal-bolus insulin therapy and glycemic control in adult patients with type 2 diabetes mellitus. DATA SOURCES: A search of the Cochrane, Medline (first search and PubMed), and CINAHL electronic databases was conducted from 2004 through 2011 using the search terms "basal-bolus insulin therapy, sliding scale insulin, glycemic control, and adult." CONCLUSIONS: Comparisons were made of glycemic control, safety, adverse events, body weight, and insulin dose showing basal-bolus insulin therapy to be at least equal, if not superior to sliding scale insulin for the patient with type 2 diabetes mellitus...
June 2014: Journal of the American Association of Nurse Practitioners
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