Indirect Support for the Use of Supplemental Insulin in Hospitalized Insulin-Requiring Diabetic Patients
- Mayer B. Davidson, MD1,
- Stanton Dulan, BA1,
- Petra Duran, BA1 and
- Mohsen Bazargan, PHD2
- 1Clinical Trials Unit, Charles R. Drew University, Los Angeles, California
- 2EPISTAT, Charles R. Drew University, Los Angeles, California
- Address correspondence and reprint requests to Mayer B. Davidson, MD, Director, Clinical Trials Unit, Charles R. Drew University, 1731 East 120th St., Los Angeles, CA 90059. E-mail: madavids{at}cdrewu.edu
Hyperglycemia has detrimental effects on many physiological processes, e.g., causing phagocytic dysfunction, immune suppression, enhanced thrombosis, and increased inflammation (1). This translates into worse outcomes in those hospitalized patients with stroke, myocardial infarction, or sepsis (1).
A common method for treating hyperglycemia in hospitalized patients utilizes a sliding scale approach with short-acting insulin. There is general agreement in the literature that the sliding scale method is not very effective (2–14). A major reason is the underlying rationale for the sliding scale method, i.e., one waits until the glucose concentration reaches a certain level (often 200 mg/dl) before one treats it. Thus, instead of attempting to prevent hyperglycemia, this approach waits until it occurs before dealing with it.
There have never been (and probably never will be) published randomized trials comparing different modes of treating hyperglycemia in hospitalized patients. Based on the poor outcome of the sliding scale method (2–14 …
