Nutritional insulin after meals may significantly reduce hypoglycemia risk in hospitalized patients: Study

A new study published in the journal of Diabetes Care and Clinical Practice showed that nutritional insulin administered after meals instead of before decreased the risk of hypoglycemia in hospitalized patients without appreciably lengthening their stay or causing severe hyperglycemia.

Hypoglycemia is a frequent occurrence on the patient days in intensive care units (10%) and non-intensive care units (3.5%), at least one hypoglycemic incident was seen. Hypoglycemia is associated with a considerable morbidity and mortality risk, particularly in the older population, with some studies suggesting a 3.4-fold greater risk of death. Insulin dosage errors are the most frequent cause of hypoglycemia in hospitalized patients when such patients have reduced calorie intake. While postprandial administration of most rapid-acting insulin analogs is allowed, they are often provided before meal consumption to enable enough time for absorption and an increase in plasma insulin levels to counteract postprandial blood sugar spikes. Thereby, Merit George and colleagues thus set out to investigate whether alterations in glycemic control or length of stay (LOS) might be brought about by a hospital-wide strategy that switched nutritional insulin delivery from pre-meal to post-meal.

This retrospective cohort research investigated the association between glycemia measurements and when nutritional insulin was administered to patients admitted to the Johns Hopkins Howard County Medical Center in Columbia, Maryland. This retrospective research, conducted over three time periods in a community hospital, assessed adult inpatients receiving nutritional insulin as Pre-intervention, post-intervention right away, and post-intervention later. These results encompassed the daily mean glucose level, LOS, severe hypoglycemia (≤ 40 mg/dL), moderate hypoglycemia (< 54 mg/dL) and severe hyperglycemia (≥ 300 mg/dL).

Between the three cohorts, the total number of patient-days studied were 1948, 1751, and 3244, respectively. The likelihood of experiencing severe hypoglycemia and any hypoglycemia reduced with time after multivariate correction. Over time, the daily mean glucose increased (194.6 ± 62.5 vs 196.8 ± 65.5 vs 199.3 ± 61.5 mg/dL; p = 0.003), despite the incidence of severe hyperglycemia (p = 0.10) and LOS (p = 0.74) did not change significantly.

By adopting a postprandial nutritional insulin delivery strategy throughout the whole hospital lowered the incidence of hypoglycemia while keeping the rate of severe hyperglycemia at bay. This implies a viable approach to enhance patient safety and more prospective randomized controlled studies are imperative to validate these results.

Source:

George, M., Zilbermint, M., Sokolinsky, S., Batty, K., Motevalli, M., Stanback, C., Gonzales, E., Miller, C., Sequeira, L., & Demidowich, A. P. (2024). Effects of preprandial versus postprandial nutritional insulin administration in the inpatient setting. In Diabetes Research and Clinical Practice (Vol. 214, p. 111785). Elsevier BV. https://doi.org/10.1016/j.diabres.2024.111785