Optimizing inpatient glycemic control with basal-bolus insulin therapy

Area of Science:

• Internal Medicine
• Endocrinology
• Diabetes Management

Background:

• Hyperglycemia is common in acute care, increasing patient morbidity and mortality.
• Current glycemic control is often suboptimal due to reliance on outdated sliding-scale insulin (SSI) regimens.
• SSI lacks scheduled basal and prandial insulin, leading to poor glucose regulation.

Purpose of the Study:

• To highlight the limitations of SSI in inpatient settings.
• To advocate for the adoption of scheduled basal-bolus insulin therapy for improved inpatient glycemic control.
• To emphasize the benefits of insulin analogs and standardized protocols.

Main Methods:

• Review of current literature on inpatient glycemic control strategies.
• Critique of the ineffectiveness and risks associated with sliding-scale insulin.
• Discussion of the components of effective basal-bolus insulin therapy.

Main Results:

• Sliding-scale insulin remains the most common inpatient subcutaneous insulin regimen despite decades of criticism.
• Basal-bolus insulin therapy, including basal, nutritional, and correctional insulin, is proposed as a superior alternative.
• Insulin analogs offer physiologic action, reduced hypoglycemia risk, and convenience compared to human insulins.

Conclusions:

• Transitioning to basal-bolus insulin therapy is crucial for optimizing inpatient diabetes management.
• Standardized insulin protocols and order sets are essential for successful implementation.
• Further research is needed to fully establish the efficacy and tolerability of these improved inpatient diabetes management programs.