Placement on New ISF-Based Scales Helps Achieve Blood Glucose Targets

New scales based on insulin sensitivity factors (ISF) have demonstrated efficacy in achieving target blood glucose values compared with the conventional single sliding scale, according to study results presented at the American Association of Clinical Endocrinology annual meeting, held online from May 26 to May 29, 2021.

This retrospective cohort study included 310 individuals with diabetes mellitus who were admitted to the hospital; those who were pregnant or had end-stage renal disease were not included. A total of 28 were placed on a new, tailored ISF-based scale (yielding 585 blood glucose values), and 282 were placed on a single sliding scale (yielding 3097 blood glucose values).

The study researchers used 6 order sets for insulin correction scales (50, 40, 30, 25, 20, and 15), which accounted for the most commonly used ISF. The percentage of target-range blood glucose values (70-180 mg/dL) was compared with the percentage of out-of-target-range values (hypoglycemic <70 mg/dL; hyperglycemic >180 mg/dL).

To determine the probability of achieving target blood glucose values, constructed logistic regression models were used with adjustments for body mass index (BMI), age, length of hospitalization, gender, race, and smoking status.

Among those placed on a single sliding scale, 29.4% (n=909) achieved the target blood glucose range; among the 2188 individuals who did not, 68.1% were hyperglycemic, and 2.5% were hypoglycemic.

In the group placed on tailored ISF-based scales, 55.9% (n=327) achieved the target glycemic range, and among the 258 who did not, 41.7% were hyperglycemic, and 2.4% were hypoglycemic.

Individuals on the ISF-based scales were 2.57 (95% CI, 2.13-3.10; P <.0001) times likelier to achieve target blood glucose levels after adjustments for BMI, age, gender, race, and smoking status. After adjustment for days of hospitalization, the association remained significant (odds ratio 1.87 [95% CI, 1.51-2.32; P <.0001]).

The study researchers concluded that “being placed on the new tailored ISF-based scales significantly improves the likelihood of achieving [blood glucose] values in the target range compared [with] being placed on a single sliding scale.”

Reference

Hester J, Coleman S, Nimmo T, et al. Tailored insulin sensitivity factor based correction scales for hospitalized patients with diabetes. Poster presented at: AACE Envision 2021; May 26-29, 2021; virtual.