Evaluation of Glycemic Control Using NPH Insulin Sliding Scale Versus Insulin Aspart Sliding Scale in Continuously Tube-Fed Patients

Background: Hyperglycemia is often a problem in patients who receive continuous enteral nutrition. The purpose of this Study was to determine if the use of sliding-scale neutral protamine Hagedorn (NPH) insulin was more effective than sliding-scale insulin aspart in controlling blood glucose in continuously tube-fed patients. Methods: A retrospective, records-based review comparing sliding-scale NPH insulin given every, 4 or 6 hours with sliding-scale insulin aspart was performed in patients admitted to 2 community hospitals between April 1, 2006, and September 30, 2007. Results: Mean blood glucose was found to be lower in patients receiving NPH every 4 hours and NPH every 6 hours than in patients receiving insulin aspart (P < .001). No statistically significant differences in mean blood glucose values (P = .41) were observed between patients receiving the NPH regimen given every 4 or 6 hours. More patients in the NPH groups had blood glucose values in the target and acceptable ranges than those in the insulin aspart group (P < .001), but no statistical significance was observed between the groups receiving NPH every 4 hours and NPH every 6 hours (P = .41). Conclusions: In this study sliding-scale NPH insulin was demonstrated to be a safe and effective management strategy for blood glucose control in continuously tube-fed patients; NPH insulin resulted in better blood glucose control compared with insulin aspart. (Nutr Clin Pract. 2009;24:718-722)