Impact of Timing Between Insulin Administration and Meal Consumption on Glycemic Fluctuation and Outcomes in Hospitalized Patients With Type 2 Diabetes
Restricted accessResearch articleFirst published online August, 2020
Impact of Timing Between Insulin Administration and Meal Consumption on Glycemic Fluctuation and Outcomes in Hospitalized Patients With Type 2 Diabetes
The effect of time interval from insulin injection to meal consumption (“insulin-meal”) on glycemic fluctuation and outcomes is not well understood.
Objective
This study aims to investigate the impact of coordinated versus mismatched insulin-meal administration on glycemic fluctuation and outcomes among hospitalized patients with type 2 diabetes (T2D).
Methods
Hospitalized patients with T2D who received at least 1 dose of insulin as part of sliding scale regimen were included. Data such as capillary blood glucose values and insulin-meal time intervals were collected.
Results
A total of 215 patients with 840 insulin-meal encounters were eligible for the study. Compared to the insulin-meal mismatch group (n = 206), the coordinated insulin-meal administration group (n = 9) had lower mean glycemic fluctuation (6.5 [2.6] mmol/L vs 5.6 [2.5] mmol/L or 117 [47] mg/dL vs 100 [45] mg/dL). Encounters with the insulin-meal time interval of 30 to 45 minutes (n = 172) were associated with the lowest percentage of severe hyperglycemia occurrences (13%) as compared to encounters with time interval of 0 to 29 minutes (n = 280, 15%) and more than 45 minutes (n = 246, 16%).
Conclusion
Coordinated insulin-meal administration was associated with lower glycemic fluctuation among hospitalized patients with T2D.
PfuntnerAWierLMStocksC. Most Frequent Conditions in U.S. Hospitals, 2011: Statistical Brief #162. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality (US). 2006.
6.
HirschIBPaauwDSBrunzellJ, et al.Inpatient management of adults with diabetes. Diabetes Care. 1995;18(6):870–878.
7.
CohenLSSedhomLSalifuM, et al.Inpatient diabetes management: examining morning practice in an acute care setting. Diabetes Educ. 2007;33(3):483–92.
8.
FreelandBPenpraseBBAnthonyM, et al.Nursing practice patterns: timing of insulin administration and glucose monitoring in the hospital. Diabetes Educ. 2011;37(3):357–362.
9.
PomposelliJJBaxterJKIIIBabineauTJ, et al.Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr. 1998;22(2):77–81.
10.
UmpierrezGEIsaacsSDBazarganN, et al.Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–982.
11.
HandelsmanYBloomgardenZTGrunbergerG, et al.American Association of Clinical Endocrinologists and American College of Endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. Apr2015;21(suppl 1):1–87.
12.
InzucchiSEBergenstalRMBuseJB; et al.Endocrine Society. 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):140–149.
13.
UmpierrezGEHellmanRKorytkowskiMT, et al.Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38.
14.
PetznickA. Insulin management of type 2 diabetes mellitus. Am Fam Physician. 2011;84(2):183–90.
15.
ChonSLeeYJFraterrigoG, et al.Evaluation of glycemic variability in well-controlled type 2 diabetes mellitus. Diabetes Technol Ther. 2013;15(6):455–460.
16.
HirschIB. Glycemic variability: it’s not just about A1C anymore!Diabetes Technol Ther. 2005;7(5):780–783.
17.
MonnierLColetteCOwensDR, et al.Glycemic variability: the third component of the dysglycemia in diabetes. Is it important? How to measure it?J Diabetes Sci Technol. 2008;2(6):1094–100.
18.
MonnierLColetteC. Glycemic variability: should we and can we prevent it?Diabetes Care. 2008;31(suppl 2):S150–4.
19.
Al-DorziHMTamimHMArabiYM, et al.Glycaemic fluctuation predicts mortality in critically ill patients. Anaesth Intensive Care. 2010;38(4):695–702.
20.
HirschIB. Glycemic variability and diabetes complications: does it matter? Of course it does!Diabetes Care. 2015;38(8):1610–1614.
21.
MaynardGLeeJPhillipsGFinkE, et al.Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: effect of structured subcutaneous insulin orders and an insulin management algorithm. J Hosp Med. 2009;4(1):3–15.
22.
OsterbergLBlaschkeT. Adherence to medication. N Engl J Med. 2005;353(5):487–497.
23.
BraithwaiteSS. Glycemic variability in hospitalized patients: choosing metrics while awaiting the evidence. Curr Diab Rep. 2013;13(1):138–154.
24.
EgiMBellomoRStachowskiE, et al.Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006;105(2):244–252.
25.
KovatchevBPOttoECoxD, et al.Evaluation of a new measure of blood glucose variability in diabetes. Diabetes Care. 2006;29(11):2433–2438.
26.
MonnierLMasEGinetC, et al.Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295(14):1681–1687.
27.
MajumdarSRHemmelgarnBRLinM, et al.Hypoglycemia associated with hospitalization and adverse events in older people: population-based cohort study. Diabetes Care. 2013;36(11):3585–3590.
28.
TurchinAMathenyMEShubinaM, et al.Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care. 2009;32(7):1153–1157.
29.
KawahitoSKitahataHOshitaS, et al.Problems associated with glucose toxicity: role of hyperglycemia-induced oxidative stress. World J Gastroenterol. 2009;15(33):4137–4142.
30.
HallerH. Postprandial glucose and vascular disease. Diabet Med. 1997;14(suppl 3):S50–6.
31.
HanefeldM. Post-prandial hyperglycaemia and vascular disease. Int J Clin Pract Suppl. 2000;(112):13–18.
32.
FowlerMJ. Microvascular and macrovascular complications of diabetes. Clinical Diabetes. 2008;26(2):77.
33.
OngKYKwanYHTayHC, et al.Prevalence of dysglycaemic events among inpatients with diabetes mellitus: a Singaporean perspective. Singapore Med J. 2015;56(7):393–400.
34.
SwansonCMPotterDJKongableGL, et al.Update on inpatient glycemic control in hospitals in the United States. Endocr Pract. 2011;17(6):853–61.
35.
NathanDMKuenenJBorgR, et al.Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31(8):1473–1478.
36.
QuealeWSSeidlerAJBrancatiFL, et al.Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med. 1997;157(5):545–552.
37.
ScottIAHilmerSNReeveE, et al.Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–834.
