Is There an Association Between Nighttime Correction Scale Insulin and Morning Hypoglycemia in Hospitalized Patients?

Abstract

Background: Correction scale insulin therapy is commonly used in hospitals. There is limited data evaluating the relationship between correction scale administration timing and morning hypoglycemic episodes. Objective: To evaluate the association between morning hypoglycemic episodes in patients who receive their correction scale insulin before meals (AC) or before meals and at bedtime (ACHS). Methods: This is a single-center, retrospective, cohort study of hospitalized patients with a history of diabetes receiving at least 1 long-acting insulin agent. The primary endpoint was the occurrence of hypoglycemia that occurred in the morning. Secondary endpoints included hyperglycemia, hypoglycemia at any time, glycemic variability (quantified as coefficient of variation, CV), and mortality. Since subjects were not randomly assigned to the exposure, inverse probability of treatment weighting (IPTW) was used to balance factors between the study groups. Multivariable analysis for hypoglycemia was conducted using logistic regression weighted by stabilized IPTW. Results: A total of 614 subjects were included in the study with 556 subjects in the ACHS group and 58 subjects in the AC group. Significant differences in the frequency of morning hypoglycemia were not observed between the ACHS and AC groups (30.6% vs 32.8%, respectively) and this finding persisted after IPTW (OR 0.89, 95% CI 0.63-1.25). Secondary outcomes (after IPTW) showed less morning hyperglycemia (OR 0.39, 95% CI 0.26-0.60) and hyperglycemia at any time (OR 0.2, 95% CI 0.11-0.38) in the ACHS group. No difference was observed in hypoglycemia at any time (OR 0.8, 0.57-1.12), glycemic variability (P = .99), and mortality was infrequent (0.5% vs 0%). Conclusion: We did not observe an association between ACHS correction scale and morning hypoglycemia. Hyperglycemia was less frequent in the ACHS group. Our results support the continued use of ACHS correction scale insulin.