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Measuring Relative Insulin Secretion using a Co-Secreted Luciferase Surrogate

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Sliding scale insulin: will the false idol finally fall?

N W Cheung¹, D R Chipps

¹Centre for Diabetes and Endocrinology Research and Department of Diabetes and Endocrinology, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia. wah@westgate.wh.usyd.edu.au

Internal Medicine Journal

|September 24, 2010

Summary

Sliding scale insulin is commonly used but lacks evidence of benefit and may be harmful. A proactive approach using supplemental insulin is safer and more effective for hospital diabetes management.

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Area of Science:

Endocrinology
Metabolism
Clinical Pharmacy

Background:

Sliding scale insulin (SSI) is frequently prescribed in hospitals despite insufficient clinical evidence supporting its efficacy.
Concerns exist regarding potential adverse effects and suboptimal glycemic control associated with SSI.
Current clinical practice often relies on reactive insulin management rather than proactive strategies.

Purpose of the Study:

To evaluate the effectiveness and safety of proactive insulin management strategies compared to sliding scale insulin.
To review the existing evidence base for sliding scale insulin use in inpatient settings.
To advocate for the discontinuation of sliding scale insulin in favor of evidence-based approaches.

Main Methods:

Review of randomized controlled trials and clinical data comparing different insulin regimens.
Analysis of evidence supporting proactive insulin therapy, including basal-bolus and supplemental insulin strategies.
Examination of changes in insulin prescribing guidelines and charts.

Main Results:

Randomized trial data now support proactive insulin management approaches.
No robust evidence base supports the clinical benefit of sliding scale insulin.
Proactive strategies, including supplemental insulin, demonstrate improved glycemic control and safety.

Conclusions:

Sliding scale insulin use in hospitals lacks clinical benefit and may be detrimental.
Proactive insulin management, incorporating supplemental insulin, is a superior and safer alternative.
Clinical practice should transition away from sliding scale insulin towards evidence-based, proactive glycemic control strategies.