Effectiveness and Safety of Standardized Insulin Transition Protocol: A Prospective Observational Study

Presentation Number: MON 274
Date of Presentation: April 3rd, 2017

Toishi Sharma*1, Megan Lee Zaleski2, Nitin Das3, Tessey Chinna Jose4, Jose M Cabral4, Sandra F Williams4 and Carmen Vanessa Villabona4
1Clevaland Clinic Florida, Weston, FL, 2Cleveland Clinic Florida, Miami, FL, 3Cleveland Clinic Flrida, Weston, FL, 4Cleveland Clinic Florida, Weston, FL

Abstract

Despite readily available guidelines by the ADA, inadequate glucose control with episodes of both hyper-glycaemia and hypo-glycaemia are frequently reported in hospitalized patients who are transitioned from intravenous(IV) to subcutaneous(SC) insulin, and lead to increased morbidity and mortality. Very few studies have evaluated the performance of the insulin transition protocol or described a selection criteria for hospitalized patients to identify candidates for safe transition.

In our prospective observational study of 155 patients in the setting of MICU, SICU and ED. In our study, we studied patients on IV insulin who were transitioned to SC insulin and we classified them as been transitioned appropriately or inappropriately transitioned based on the following criteria for appropriate transition: 1) Blood Glucose at target(110-140 mg/dl) for 4 hours prior to transition 2) No vasopressors or intubation required at the time of transition 3) No steroids in previous 24 hours 4) patient on TPN or tube feeds at goal rate 5)Patient is on fluids with dextrose and will be continuing the same. We excluded pregnant patients and those with DKA. Frequency of hypoglycemic (BG<50 mg/dl) or hyperglycemic (BG >180 mg/dl) events in the next 24 hours after initiation of transition was assessed in the appropriately versus inappropriately transitioned groups.

The total number of transitions studied in the setting of MICU, SICU and ED were 47, 102 and 4 respectively. Lower rates of hyperglycemic events were found in appropriately transitioned groups versus inappropriately transitioned groups in all the three settings: MICU (58% vs 68%), SICU (25% vs 35%) and ER (0% vs 75%). Also, less frequent hypoglycemic events occurred in appropriately versus inappropriately transitioned patients in SICU (0% vs 4.6%) and ER (0% vs 25%). In the MICU, there were no hypoglycemic events in either group.

This study shows the effectiveness and safety of implementing a standard intravenous to subcutaneous insulin transition in all the three settings – MICU, SICU and ED and the need for detailed patient evaluation before commencing this transition

 

Nothing to Disclose: TS, MLZ, ND, TCJ, JMC, SFW, CVV