Clinical outcomes associated with the use of subcutaneous insulin-by-glucose sliding scales to manage hyperglycemia in hospitalized patients with pneumonia

被引:26
作者
Becker, Taryn [1 ]
Moldoveanu, Andrei [1 ]
Cukierman, Tali [1 ]
Gerstein, Hertzel C. [1 ]
机构
[1] Care of Dr HC Gerstein, McMaster Univ & Hamilton Hlth Sci, Dept Med, Hamilton, ON L8N 3Z5, Canada
关键词
blood glucose; pneumonia; insulin;
D O I
10.1016/j.diabres.2007.05.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Despite its ubiquitous use, the value of subcutaneous insulin-by-glucose sliding scales (SISS) for the management of inpatient hyperglycemia has not been carefully assessed. Methods: The medical charts of 391 patients >45 years of age admitted with pneumonia from January 2003 to May 2004 who had a recorded glucose within 24 h of admission and who did not have active cancer, tuberculosis or AIDS were reviewed. Abstracted data included demographics, clinical characteristics, admission and daily glucose levels, medications, SISS use and clinical outcomes. The primary outcome was pre-defined as a composite of in-hospital mortality, cardiovascular complications, sepsis or ICU admission. Results: Compared to patients not prescribed an SISS during the admission, the 47 patients prescribed an SISS had a higher rate of the following outcomes: primary outcome (OR = 2,55; 95% CI 1.38-4.73); cardiovascular complications or death (OR = 1.86; 95% CI 0.99-3.49), sepsis or ICU admission (OR = 4.98; 95% CI 2.38-10.42). The relationship between sliding scale use and the primary outcome was statistically significant, even after controlling for age, sex, diabetes, steroids, CHF and COPD (P < 0.0001). Patients receiving a sliding scale had mean in-hospital glucose values of 11.83 mmol/L versus 7.2 mmol/L (P < 0.0001) in patients not receiving an insulin sliding scale. Conclusion: Among patients admitted to a medical ward with pneumonia, an SISS is associated with higher glucose levels and poorer clinical outcomes. (c) 2007 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:392 / 397
页数:6
相关论文
共 21 条
  • [1] Eliminating inpatient sliding-scale insulin - A reeducation project with medical house staff
    Baldwin, D
    Villanueva, G
    McNutt, R
    Bhatnagar, S
    [J]. DIABETES CARE, 2005, 28 (05) : 1008 - 1011
  • [2] COMMUNITY-ACQUIRED PNEUMONIA
    BARTLETT, JG
    MUNDY, LM
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (24) : 1618 - 1624
  • [3] Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview
    Capes, SE
    Hunt, D
    Malmberg, K
    Gerstein, HC
    [J]. LANCET, 2000, 355 (9206) : 773 - 778
  • [4] Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients - A systematic overview
    Capes, SE
    Hunt, D
    Malmberg, K
    Pathak, P
    Gerstein, HC
    [J]. STROKE, 2001, 32 (10) : 2426 - 2432
  • [5] Optimal treatment strategies for community-acquired pneumonia: High-risk patients (geriatric and with comorbidity)
    Carbon, C
    [J]. CHEMOTHERAPY, 2001, 47 : 19 - 25
  • [6] Management of diabetes and is hyperglycemia in hospitals
    Clement, S
    Braithwaite, SS
    Magee, MF
    Ahmann, A
    Smith, EP
    Schafer, RG
    Hirsh, IB
    [J]. DIABETES CARE, 2004, 27 (02) : 553 - 591
  • [7] Dickerson Lori M, 2003, Ann Fam Med, V1, P29, DOI 10.1370/afm.2
  • [8] Prognosis and outcomes of patients with community-acquired pneumonia - A meta-analysis
    Fine, MJ
    Smith, MA
    Carson, CA
    Mutha, SS
    Sankey, SS
    Weissfeld, LA
    Kapoor, WN
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 275 (02): : 134 - 141
  • [9] A single serum glucose measurement predicts adverse outcomes across the whole range of acute coronary syndromes
    Foo, K
    Cooper, J
    Deaner, A
    Knight, C
    Suliman, A
    Ranjadayalan, K
    Timmis, AD
    [J]. HEART, 2003, 89 (05) : 512 - 516
  • [10] Are sliding-scale insulin regimens a recipe for diabetic instability?
    Gill, G
    MacFarlane, I
    [J]. LANCET, 1997, 349 (9064) : 1555 - 1555