Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes.
Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes.
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DOI：
10.1111/jgs.17771
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发表时间：
2022-07
影响因子：
6.3
通讯作者：
Lee, Sei J.
中科院分区：
文献类型：
--
作者：
Lam, Kenneth;Gan, Siqi;Nguyen, Brian;Jing, Bocheng;Lee, Sei J.
指南不鼓励在疗养院(NH)入院第一周后使用滑动比例胰岛素(SSI)。我们试图确定SSI的患病率，并确定与停止SSI或过渡到另一种短效胰岛素方案相关的因素。在2013年10月1日至2017年6月30日对非临终关怀退伍军人事务部NH住院患者进行的一项观察性研究中，我们比较了入院2周至12周期间SSI与其他两种短效胰岛素方案-固定剂量胰岛素(FDI)或校正剂量胰岛素(CDI，定义为可变SSI+固定剂量胰岛素)-的每周患病率。在第二周接受SSI的患者中，我们检查了与停止SSI或在第五周前转向其他方案的相关因素。这些因素包括人口统计学因素(如年龄、性别、种族/民族)、虚弱相关因素(如合并症、认知障碍、功能障碍)和糖尿病相关因素(如HbA1c、长效胰岛素使用、高血糖和低血糖)。在第二周，我们队列中21%的人使用SSI，8%使用FDI，7%使用CDI。SSI是脆弱亚群中最常见的治疗方案(例如，在我们的中重度认知障碍队列中，18%的人服用SSI，而5%的人服用FDI，4%的人服用CDI)。SSI患病率在第12周从21%稳定下降到16%(P为线性趋势<；0.001)，主要是通过停止SSI。与虚弱相关的因素相比，糖尿病相关因素(如高血糖)与持续SSI或过渡到非SSI短效胰岛素方案的相关性更强。SSI是NH居民使用短效胰岛素最常见的方法。需要做更多的研究来探索为什么在NH入院几周后仍然使用滑动比例，并探索如何用更安全、更有效和更少负担的方案来取代这种做法。
Guidelines discourage sliding scale insulin (SSI) use after the first week of a nursing home (NH) admission. We sought to determine the prevalence of SSI and identify factors associated with stopping SSI or transitioning to another short-acting insulin regimen. In an observational study from October 1, 2013 to June 30, 2017 of non-hospice Veterans Affairs NH residents with Type 2 diabetes and a NH admission over 1 week, we compared the weekly prevalence of SSI versus two other short-acting insulin regimens – fixed dose insulin (FDI) or correction dose insulin (CDI, defined as variable SSI given alongside fixed doses of insulin) – from week 2 to week 12 of admission. Among those on SSI in week 2, we examined factors associated with stopping SSI or transitioning to other regimens by week 5. Factors included demographics (eg, age, sex, race/ethnicity), frailty-related factors (eg, comorbidities, cognitive impairment, functional impairment), and diabetes-related factors (eg, HbA1c, long-acting insulin use, hyperglycemia and hypoglycemia). In week 2, 21% of our cohort was on SSI, 8% was on FDI, and 7% was on CDI. SSI was the most common regimen in frail subgroups (eg, 18% of our cohort with moderate-severe cognitive impairment was on SSI vs 5% on FDI and 4% on CDI). SSI prevalence decreased steadily from 21% to 16% at week 12 (P for linear trend < 0.001), mostly through stopping SSI. Diabetes-related factors (eg, hyperglycemia) were more strongly associated with continuing SSI or transitioning to a non-SSI short-acting insulin regimen than frailty-related factors. SSI is the most common method of administering short-acting insulin in NH residents. More research needs to be done to explore why sliding scale use persists weeks after NH admission and explore how we can replace this practice with safer, more effective and less burdensome regimens.
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影响因子：
16.2
作者：
Munshi MN;Florez H;Huang ES;Kalyani RR;Mupanomunda M;Pandya N;Swift CS;Taveira TH;Haas LB
通讯作者：
Haas LB
影响因子：
6.3
作者：
Jeon SY;Shi Y;Lee AK;Hunt L;Lipska K;Boscardin J;Lee S
通讯作者：
Lee S
DOI：
10.1016/j.jamda.2008.06.003
发表时间：
2008-11-01
影响因子：
7.6
作者：
Pandya, Naushira;Thompson, Stephen;Sambamoorthi, Usha
通讯作者：
Sambamoorthi, Usha
DOI：
10.1016/j.jamda.2015.08.015
发表时间：
2016-03-01
影响因子：
7.6
作者：
Dharmarajan, Thiruvinvamalai S.;Mahajan, Dheeraj;Norkus, Edward P.
通讯作者：
Norkus, Edward P.
影响因子：
6.3
作者：
Pandya, Naushira;Wei, Wenhui;Davis, Keith L.
通讯作者：
Davis, Keith L.