%0 Journal Article
%T Effects of preprandial versus postprandial nutritional insulin administration in the inpatient setting.
%A George M
%A Zilbermint M
%A Sokolinsky S
%A Batty K
%A Motevalli M
%A Stanback C
%A Gonzales E
%A Miller C
%A Sequeira L
%A Demidowich AP
%J Diabetes Res Clin Pract
%V 214
%N 0
%D 2024 Aug 15
%M 39019331
%F 8.18
%R 10.1016/j.diabres.2024.111785
%X <B>OBJECTIVE: </B>Hospitalized patients can have inconsistent nutritional intake due to acute illness, changing diet, or unpredictable meal delivery. The aim of this study was to evaluate whether implementation of a hospital-wide policy shifting nutritional insulin administration from pre-meal to post-meal was associated with changes in glycemic control or length of stay (LOS).<BR><B>METHODS: </B>This retrospective study performed at a community hospital evaluated adult inpatients receiving nutritional insulin across three time periods. pre-intervention, immediate post-intervention, and distant post-intervention. Outcomes included rates of hypoglycemia (glucose ≤ 70 mg/dL), moderate hypoglycemia (< 54 mg/dL), severe hypoglycemia (≤ 40 mg/dL), severe hyperglycemia (≥ 300 mg/dL), daily mean glucose level, and LOS.<BR><B>RESULTS: </B>The number of patient-days analyzed across the cohorts were 1948, 1751, and 3244, respectively. After multivariate adjustment, risk of developing any hypoglycemia and severe hypoglycemia significantly decreased over time (p = 0.001 and p = 0.009, respectively). Daily mean glucose increased over time (194.6 ± 62.5 vs 196.8 ± 65.5 vs 199.3 ± 61.5 mg/dL; p = 0.003), but there were no significant differences among rates of severe hyperglycemia (p = 0.10) or LOS (p = 0.74).<BR><B>CONCLUSIONS: </B>Implementing a hospital-wide shift to postprandial nutritional insulin administration significantly reduced hypoglycemia rates without increasing severe hyperglycemia. This suggests a promising strategy for improving patient safety, but further prospective randomized controlled trials are warranted to confirm these findings.