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- Title
Prandial Insulin Dosing Using the Carbohydrate Counting Technique in Hospitalized Patients With Type 2 Diabetes.
- Authors
DUNGAN, KATHLEEN M.; SAGRILLA, COLLEEN; ABDEL-RASOUL, MAHMOUD; OSEI, KWAME
- Abstract
OBJECTIVE-To compare a modified fixed meal dosing strategy to flexible meal dosing in hospitalized patients with type 2 diabetes. RESEARCH DESIGN AND METHODS-Patients (N = 126) with refractory hyperglycemia or requiring at least 20 units of insulin per day were randomly assigned to fixed meal dosing (including withholding the dose if less than half of themeal traywas consumed) or flexible meal dosing based upon carbohydrate intake. The inpatient diabetes management team made all treatment adjustments. Outcomes included day 3 mean glucose, 72-h glucose trend analysis, hypoglycemia (<3.9 mmol/L), and inpatient diabetes treatment satisfaction. RESULTS-The mean glucose on day 3 was 9.5 and 8.8 mmol/L in the fixed and flexible meal groups, respectively (P = 0.26). The frequency of hypoglycemia was 23 and 39% overall in the fixed and flexible meal groups (P = 0.08), with half of events occurring in the morning. There was a wide range of carbohydrate intake (median 51 g/meal, 10-90% range 26-72 g on day 3). The fixed dose group required significantly more prandial insulin overall and more correction insulin over time. There was no difference in composite treatment satisfaction or dosing miscalculations between groups. CONCLUSIONS-A fixed meal dosing strategy provided similar glucose control as flexible meal dosing, when managed by an inpatient diabetes treatment team. However, a larger sample size would be needed to definitively evaluate a treatment effect of flexible meal dosing in the hospital. Further study is needed to improve the delivery of bolus insulin in hospitalized patients.
- Subjects
INSULIN therapy; PEOPLE with diabetes; HOSPITAL patients -- Nutrition; HYPERGLYCEMIA; DIETARY carbohydrates
- Publication
Diabetes Care, 2013, Vol 36, Issue 11, p3476
- ISSN
0149-5992
- Publication type
Article
- DOI
10.2337/dc13-0121