Should We Prescribe Sliding Scale Insulin Alone for Patients Hospitalized with Diabetes?

Current guidelines recommend against sliding scale insulin (SSI) alone for managing inpatients with hyperglycemia (J Clin Endocrinol Metab 2012; 97:16), but those recommendations were based on just a few small- to moderate-sized randomized trials. Now, investigators used a retrospective cohort design to evaluate ≈8000 non–intensive care unit (ICU) inpatients with type 2 diabetes who were treated with sliding scale insulin alone during the first 48 hours of hospitalization at three Georgia hospitals.

Glycemic control throughout the hospital stay — defined as mean hospital blood glucose (BG) level between 70 mg/dL and 180 mg/dL, without episodes of hypoglycemia (i.e., BG <70 mg/dL), while remaining on SSI — were as follows:

• Patients with admission blood glucose (BG) levels <140 mg/dL or between 140 mg/dL and 180 mg/dL achieved control ≈85% of the time.

• Patients with admission BG between 180 mg/dL and 250 mg/dL or ≥250 mg/dL achieved control 53% and 18% of the time, respectively.

International experts also published guidance for managing non-ICU inpatients with type 2 diabetes. They recommend SSI alone (or SSI plus oral antidiabetic agents) for the following patient subsets: patients with new diabetes; patients with established diabetes who use low-complexity outpatient oral diabetic regimens (<3 home oral agents); and inpatients whose BG is <200mg/dL, whose glycosylated hemoglobin level is <7.5%, who have poor oral intake, or who are at high risk for hypoglycemia (i.e., renal dysfunction, frailty, or advanced age). A chart with recommended treatment regimens is included in the original article.