Association Between Daily Insulin Dose Adjustments and Glycemic Control in Noncritically Ill Hospitalized...

To evaluate the efficacy of daily insulin dose increases in managing inpatient hyperglycemia.

Retrospective study of patients discharged from 2 urban academic medical centers and 3 large suburban community hospitals between 2015 and 2019 who received ≥10 units of basal insulin on any day. On hyperglycemic days (mean glucose ≥180 mg/dL), we categorized the relative insulin dose increases into 4 categories based on percentage changes from the previous day. We further subclassified these categories according to the average blood glucose (BG), total daily dose (TDD), and weight-based dosing quartiles. The primary goal was achieving an average BG of ≤160 mg/dL without subsequent hypoglycemia (≤70 mg/dL) on the following day.

From 25 186 hospital admissions, we collected data on 240 556 hospital days and 63 033 hyperglycemic index days. The median age was 64, with 53.4% being male and 52.1% White. The median BG level was 222.7 mg/dL. Type 2 diabetes was coded in 54.7%, while 36.3% lacked a diabetes code but received basal insulin. Insulin dose adjustments showed a strong correlation with glycemic control; specifically, a 44% to 100% increase in TDD was significantly more likely to achieve the primary outcome, compared to a TDD increase of 10% to 22%. This trend remained consistent across varied BG ranges and dosing categories.

More intensive insulin adjustments may be required for inpatient hyperglycemia compared to the typical 10% to 20% recommendation. Prospective studies are needed to validate and build upon these retrospective findings.