Burden of Sliding Scale Insulin Use in Elderly Long-Term Care Residents with Type 2 Diabetes Mellitus
Burden of Sliding Scale Insulin Use in Elderly Long-Term Care Residents with Type 2 Diabetes Mellitus
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DOI：
10.1111/jgs.12547
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发表时间：
2013-12-01
影响因子：
6.3
通讯作者：
Davis, Keith L.
中科院分区：
文献类型：
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作者：
Pandya, Naushira;Wei, Wenhui;Davis, Keith L.
目的研究2型糖尿病（T2 DM）老年人中滑动标度胰岛素（SSI）治疗的患病率、实践模式和相关负担。设计一项回顾性横断面研究，评估合并的医疗图表数据和最小数据集。设置美国7个州的117家长期护理（LTC）机构。096）在2009年1月1日之后入住LTC机构，在图表提取之前已在该机构至少3个月，并接受了非SSI或SSI方案的治疗。后者分为仅SSI、基础SSI、餐时SSI、基础-餐时-SSI和SSI的多种方案。收集2010年9月至2011年9月的数据。手指针刺负荷评估为每周手指针刺的平均次数和随后未给予胰岛素的平均次数。其他措施包括糖化血红蛋白（HbA 1c）和低血糖events.ResultsOverall，73.8%的参与者接受SSI治疗。SSI治疗的参与者比非SSI治疗的参与者更可能是年轻的（P= 0.01），非白人（P= 0.002）和接受磺酰脲类药物（P= 0.004）。SSI治疗与每周19.9 +/- 7.9次手指针刺的平均标准差相关，其中12.5 +/- 7.6次未进行胰岛素给药。与非SSI治疗的受试者相比，SSI治疗的受试者中有一个或多个HbA 1c测量值≤ 7.0%（48.8% vs 57.2%）或≤ 8.5%（85.2% vs 87.6%）的受试者较少。两组低血糖发生率相似（15.0% vs 14.9%）。ConclusionSSI治疗广泛应用于LTC设施，并与高手指针刺负担相关。SSI方案与较差的血糖控制相关，但低血糖发生率与非SSI方案相似。
ObjectivesTo examine prevalence, practice patterns, and associated burden of sliding scale insulin (SSI) therapy in elderly adults with type 2 diabetes (T2DM).DesignA retrospective cross-sectional study assessing merged medical chart data and the Minimum Data Set.SettingOne hundred seventeen long-term care (LTC) facilities in seven U.S. states.ParticipantsElderly adults with insulin-treated T2DM (N=2,096) admitted to a LTC facility after January 1, 2009, who had been in the facility for at least 3months before chart abstraction and had received treatment with non-SSI or SSI regimens. The latter were categorized into SSI-only, basal-SSI, prandial-SSI, basal-prandial-SSI, and multiple regimens with SSI. Data were collected from September 2010 through September 2011.MeasurementsDemographic and clinical characteristics were recorded. Fingerstick burden was assessed as the average number of fingersticks per week and average number without subsequent insulin administration. Other measures included glycosylated hemoglobin (HbA1c) and hypoglycemia events.ResultsOverall, 73.8% of participants received SSI therapy. SSI-treated participants were more likely to be younger (P=.01), non-white (P=.002), and receiving sulfonylurea (P=.004) than non-SSI treated participants. SSI therapy was associated with a meanstandard deviation of 19.9 +/- 7.9 fingersticks per week, of which 12.5 +/- 7.6 were not followed by insulin administration. Fewer SSI-treated participants than non-SSI treated participants had one or more HbA1c measurements of 7.0% or less (48.8% vs 57.2%) or 8.5% or less (85.2% vs 87.6%, respectively). Rates of hypoglycemia were similar in both groups (15.0% vs 14.9%).ConclusionSSI therapy is widely used in LTC facilities and is associated with a high fingerstick burden. SSI regimens are associated with poorer glycemic control but a rate of hypoglycemia similar to that of non-SSI regimens.