ArticleEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists2025
Association Between Daily Insulin Dose Adjustments and Glycemic Control in Noncritically Ill Hospitalized Hyperglycemic Patients: A Retrospective Cohort Study.
Article in Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- A retrospective sub-study of perioperative glycaemia and insulin treatment for hospital inpatients at a quaternary centre from the specialist treatment of inpatients: Caring for diabetes in surgery trial (STOIC-D Surgery).Diabetic medicine : a journal of the British Diabetic Association · 2026Trial
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5 authors.
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Abstract
objectiveTo evaluate the efficacy of daily insulin dose increases in managing inpatient hyperglycemia.
methodsRetrospective 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.
resultsFrom 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.
conclusionMore 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.
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