Initial use of insulin in hospitalized patients with type 2 diabetes mellitus
PDF (Español (España))

Keywords

Insulin Therapy
Type 2 Diabetes Mellitus
Hyperglycemia
Hospitalization/Inpatient
Antidiabetic drugs
Oral hypoglycemics

How to Cite

Sprockel Díaz, J. J. ., Martínez Arias, L. O. ., Pérez Murcia, A. M. ., Abella Díaz, A. L. ., Sarmiento Ângulo, P., Mendieta Roa, D. E. ., & Medina Orjuela, A. (2022). Initial use of insulin in hospitalized patients with type 2 diabetes mellitus. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 8(4). https://doi.org/10.53853/encr.8.4.714

Abstract

Background: Hyperglycemia in hospitalized patients is related to the development of complications and in-hospital mortality, currently its treatment is focused on the use of insulins. The intrahospital insulin formulation practices in our setting are unknown.

Purpose: To describe the insulinization schemes used in hospitalized type 2 diabetic patients (DM2), without a history of insulin use, as well as their indication and prescription at discharge.

Methodology: Retrospective cross-sectional study, which included adult patients hospitalized in two university hospitals during 2018 who were prescribed insulin for the management of DM2.

Results: 383 patients were included, 67 years of average age and 53% women. The indications for the initiation of insulin were being hospitalized (73.9%), diabetes decompensations and elevated HbA1c. The schemes used from highest to lowest frequency were basal 55.6%, basal / bolus 43.6%, and basal / plus 0.8%. The most used long-acting insulin was glargine in 95.8% of the cases and the short-acting glulisine in 69.4% of the cases. 244 (77.2%) patients were discharged with insulin therapy, of which 46.7% had a glycated hemoglobin (HbA1c) <10% and 83.2% were discharged without oral hypoglycemic drug, of which 96% had no contraindications for its use and 34% had Hb1Ac ?10%.

Conclusions: In hospitalized type 2 diabetics, the main indication for the initiation of insulin was the hospitalization itself. Basal and basal / bolus schemes predominated in a similar proportion and preference was shown for the use of insulin analogues, especially glargine and glulisine. The insulin prescription at discharge was high, with low use of oral antidiabetic drugs despite having no contraindication.

https://doi.org/10.53853/encr.8.4.714
PDF (Español (España))

References

Polonsky KS, Burant CF. Diabetes mellitus de tipo 2. En: Melmed SM, Polonsky KS, Larsen PR, Kronenberg HM, editores. Williams. Tratado de endocrinología; 2017. p. 1386-450.

Dall TM, Yang W, Gillespie K, Mocarski M, Byrne E, Cintina I, et al. The Economic Burden of Elevated Blood Glucose Levels in 2017: Diagnosed and Undiagnosed Diabetes, Gestational Diabetes Mellitus, and Prediabetes. Diabetes Care. 2019;42(9):1661. DOI: https://doi.org/10.2337/dc18-1226

Aschner P. Epidemiología de la diabetes en Colombia. Av Diabetol. 2010;26(2):95-100. DOI: https://doi.org/10.1016/S1134-3230(10)62005-4

American Diabetes Association. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes - 2021. Diabetes Care. 2021;44(supl. 1):S211-20. DOI: https://doi.org/10.2337/dc21-S015

Sistema General de Seguridad Social en Salud - Colombia. Guía de práctica clínica para el diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población mayor de 18 años [Internet]. Colombia: Ministerio de Salud y Protección Social; 2016 [citado 2021 oct. 10]. Disponible en: https://www.iets.org.co/Archivos/47/DIABETES_TIPO_2_COMPLETA.pdf

Revista ALAD. Guías ALAD sobre el Diagnóstico, Control y Tratamiento de la Diabetes Mellitus Tipo 2 con Medicina Basada en Evidencia [Internet]. México: Permanyer México; 2019 [citado 2021 oct. 10]. Disponible en: https://www.revistaalad.com/guias/5600AX191_guias_alad_2019.pdf

Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140-9. DOI: https://doi.org/10.2337/dc14-2441

Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm-2016 executive summary. Endocr Pract. 2016;22(1):84-113. DOI: https://doi.org/10.4158/EP151126.CS

National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. (NICE guideline 28) 2015 [Internet]. Disponible en: www.nice.org.uk/guidance/ng28

Aschner P. New IDF clinical practice recommendations for managing type 2 diabetes in primary care. Diabetes Res Clin Pract. 2017;132:169-70. DOI: https://doi.org/10.1016/j.diabres.2017.09.002

Pérez A, Ramos A, Carreras G. Insulin Therapy in Hospitalized Patients. Am J Ther. 2020;27(1):e71-e8. DOI: https://doi.org/10.1097/MJT.0000000000001078

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359-67. DOI: https://doi.org/10.1056/NEJMoa011300

Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(5):1007-21. DOI: https://doi.org/10.1067/mtc.2003.181

Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449-61. DOI: https://doi.org/10.1056/NEJMoa052521

Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-97. DOI: https://doi.org/10.1056/NEJMoa0810625

Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (Rabbit 2 surgery). Diabetes Care. 2011;34(2):256-61. DOI: https://doi.org/10.2337/dc10-1407

Pérez AP, Gutiérrez PC, Diosdado MA, Martínez VB, Anuncibay PG, de Casasola GG, et al. Tratamiento de la hiperglucemia en el hospital. Endocrinol Nutr. 2009;56(6):303-16. DOI: https://doi.org/10.1016/S1575-0922(09)71945-X

American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020 en.;43(supl. 1):S98-110. DOI: https://doi.org/10.2337/dc20-S009

Khazai NB, Hamdy O. Inpatient Diabetes Management in the Twenty-First Century. Endocrinol Metab Clin North Am. 2016;45(4):875-94. DOI: https://doi.org/10.1016/j.ecl.2016.06.013

Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm-2016 executive summary. Endocr Pract. 2016;22(1):84-113. DOI: https://doi.org/10.4158/EP151126.CS

National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. (NICE guideline 28.) 2015 [Internet]. Disponible en: www.nice.org.uk/guidance/ng28

Kodner C, Anderson L, Pohlgeers K. Glucose Management in Hospitalized Patients. Am Fam Physician. 2017;96(10):648-54.

Fushimi N, Shibuya T, Yoshida Y, Ito S, Hachiya H, Mori A. Dulaglutide-combined basal plus correction insulin therapy contributes to ideal glycemic control in non-critical hospitalized patients. J Diabetes Investig. 2020;11(1):125-31. DOI: https://doi.org/10.1111/jdi.13093

Fayfman M, Galindo RJ, Rubin DJ, Mize DL, Anzola I, Urrutia MA, et al. A Randomized Controlled Trial on the Safety and Efficacy of Exenatide Therapy for the Inpatient Management of General Medicine and Surgery Patients With Type 2 Diabetes. Diabetes Care. 2019;42(3):450-6. DOI: https://doi.org/10.2337/dc18-1760

Pérez-Belmonte LM, Osuna-Sánchez J, Millán-Gómez M, López-Carmona MD, Gómez-Doblas JJ, Cobos-Palacios L, et al. Glycaemic efficacy and safety of linagliptin for the management of non-cardiac surgery patients with type 2 diabetes in a real-world setting: Lina-Surg study. Ann Med. 2019;51(3-4):252-61. DOI: https://doi.org/10.1080/07853890.2019.1613672

Vellanki P, Rasouli N, Baldwin D, Alexanian S, Anzola I, Urrutia M, et al. Glycaemic efficacy and safety of linagliptin compared to a basal-bolus insulin regimen in patients with type 2 diabetes undergoing non-cardiac surgery: A multicentre randomized clinical trial. Diabetes Obes Metab. 2019;21(4):837-43. DOI: https://doi.org/10.1111/dom.13587

U. S. Food and Drug Administration. FDA Drug Safety Communication: FDA adds warnings about heart failure risk to labels of type 2 diabetes medicines containing saxagliptin and alogliptin [Internet]. Estados Unidos: FDA; 2014 [citado 2019 oct. 28]. Disponible en: http://www.fda.gov/Drugs/DrugSafety/ucm486096.htm

Umpierrez GE, Hor T, Smiley D, Temponi A, Umpierrez D, Ceron M, et al. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009;94(2):564-9. DOI: https://doi.org/10.1210/jc.2008-1441

Guerra YS, Lacuesta EA, Yrastorza R, Miernik J, Shakya N, Fogelfeld L. Insulin injections in relation to meals in the hospital medicine ward: comparison of 2 protocols. Endocr Pract. 2011;17(5):737-46. DOI: https://doi.org/10.4158/EP10358.OR

Meyer C, Boron A, Plummer E, Voltchenok M, Vedda R. Glulisine versus human regular insulin in combination with glargine in noncritically ill hospitalized patients with type 2 diabetes: a randomized double-blind study. Diabetes Care. 2010;33(12):2496-501. DOI: https://doi.org/10.2337/dc10-0957

Bueno E, Benitez A, Rufinelli JV, Figueredo R, Alsina S, Ojeda A, et al. Basal-bolus regimen with insulin analogues versus human insulin in medical patients with type 2 diabetes: a randomized controlled trial in Latin America. Endocr Pract. 2015;21(7):807-13. DOI: https://doi.org/10.4158/EP15675.OR

Bellido V, Suarez L, Rodríguez MG, Sánchez C, Dieguez M, Riestra M, et al. Comparison of Basal-Bolus and Premixed Insulin Regimens in Hospitalized Patients With Type 2 Diabetes. Diabetes Care. 2015;38(12):2211-6. DOI: https://doi.org/10.2337/dc15-0160

Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (Rabbit 2 trial). Diabetes Care. 2007;30(9):2181-6. DOI: https://doi.org/10.2337/dc07-0295

Hirsch IB. Sliding scale insulin-time to stop sliding. JAMA. 2009;301(2):213-4. DOI: https://doi.org/10.1001/jama.2008.943

Lee YY, Lin YM, Leu WJ, Wu MY, Tseng JH, Hsu MT, et al. Sliding-scale insulin used for blood glucose control: a meta-analysis of randomized controlled trials. Metabolism. 2015;64(9):1183-92. DOI: https://doi.org/10.1016/j.metabol.2015.05.011

Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med. 2007;120(7):563-7. DOI: https://doi.org/10.1016/j.amjmed.2006.05.070

Baldwin D, Villanueva G, McNutt R, Bhatnagar S. Eliminating inpatient sliding-scale insulin: a reeducation project with medical house staff. Diabetes Care. 2005;28(5):1008-11. DOI: https://doi.org/10.2337/diacare.28.5.1008

Heise T, Kaplan K, Haahr HL. Day-to-Day and Within-Day Variability in Glucose-Lowering Effect Between Insulin Degludec and Insulin Glargine (100 U/mL and 300 U/mL): A Comparison Across Studies. J Diabetes Sci Technol. 2018;12(2):356-63. DOI: https://doi.org/10.1177/1932296817731422

Zhang XW, Zhang XL, Xu B, Kang LN. Comparative safety and efficacy of insulin degludec with insulin glargine in type 2 and type 1 diabetes: a meta-analysis of randomized controlled trials. Acta Diabetol. 2018;55(5):429-41. DOI: https://doi.org/10.1007/s00592-018-1107-1

Wysham C, Bhargava A, Chaykin L, de la Rosa R, Handelsman Y, Troelsen LN, et al. Effect of Insulin Degludec vs Insulin Glargine U100 on Hypoglycemia in Patients With Type 2 Diabetes: The SWITCH 2 Randomized Clinical Trial. JAMA. 2017;318(1):45-56. DOI: https://doi.org/10.1001/jama.2017.7117

Galindo R, Pasquel F, Vellanki P, Alicic R, Lam D, Fayfman M, et al. Degludec hospital trial: A randomized controlled trialcomparing insulin degludec U100 and glargine U100 forthe inpatient management of patients with type 2 diabetes. Diabetes Obes Metab. 2022;24(1):42-9. DOI: https://doi.org/10.1111/dom.14544

Pasquel F, Lansang C, Khowaja A, Urrutia A, Cardona S, Albury B, et al. A Randomized Controlled Trial Comparing Glargine U300 and Glargine U100 for the Inpatient Management of Medicine and Surgery Patients With Type 2 Diabetes: Glargine U300 Hospital Trial. Diabetes Care. 2020;43:1242-8. DOI: https://doi.org/10.2337/dc19-1940

Fragozo A, Puerta MF, Misas JD. Comparative analysis of insulin glargine vs. insulin detemir: A cost-minimization study applicable to Colombia. Biomédica. 2015;35(2):204-11. DOI: https://doi.org/10.7705/biomedica.v35i2.2338

Capson J, Cade K. Detemir Vs Glargine: Comparison of Inpatient Glycemic Control. J Am Osteopath Assoc. 2019 febr. 1;119(2):89-95. DOI: https://doi.org/10.7556/jaoa.2019.014

Lane WS, Weatherall J, Gundgaard J, Pollock RF. Insulin degludec versus insulin glargine U100 for patients with type 1 or type 2 diabetes in the US: a budget impact analysis with rebate tables. J Med Econ. 2018;21(2):144-51. DOI: https://doi.org/10.1080/13696998.2017.1384383

Chao M, Wang W, Zhang Y, Lu X, Meng J, Ning G. Bioequivalence between two human insulin analogs in Chinese population: Glulisine and Lispro. Endocrine. 2010;38(1):48-52. DOI: https://doi.org/10.1007/s12020-010-9326-4

Fullerton B, Siebenhofer A, Jeitler K, Horvath K, Semlitsch T, Berghold A, et al. Short-acting insulin analogues versus regular human insulin for adult, non-pregnant persons with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2018;12:CD013228. DOI: https://doi.org/10.1002/14651858.CD013228

Urata H, Mori K, Emoto M, Yamazaki Y, Motoyama K, Morioka T, et al. Advantage of insulin glulisine over regular insulin in patients with type 2 diabetes and severe renal insufficiency. J Ren Nutr. 2015;25(2):129-34. DOI: https://doi.org/10.1053/j.jrn.2014.07.011

Gómez-Huelgas R, Sabán-Ruiz J, García-Román FJ, Quintela-Fernández N, Seguí-Ripoll JM, Bonilla-Hernández MV, et al. Safety and efficacy of a basal-plus regimen with insulin glargine and insulin glulisine for elderly patients with high cardiovascular risk and type 2 diabetes mellitus. Rev Clin Esp. 2017;217(4):201-6. DOI: https://doi.org/10.1016/j.rce.2017.02.005

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Downloads

Download data is not yet available.