Comparative analysis between the therapy of sliding scale insulin and basal-bolus insulin in a hospital emergency

Abstract

BACKGROUND: Diabetes mellitus (DM) is a chronic metabolic illness with a high prevalence in our population, approximately 13,8% has a DM background and 6% of them haven’t been diagnosed yet. In the emergency services, about 30-40% of patients are diabetic regardless of the reason for consultation. On many occasions, the control of blood glucose is not appropriate, as it has been proven in various studies in which blood sugar level has kept over 140 mg/dl. This situation worsens the prognosis, increases medical complications, and lowers the survival rate of diabetic patients. That’s why it is necessary to stablish protocols that have scientifically proven a good control of blood sugar levels. In Cataluña, the Catalan Society of Urgencies and Emergencies diabetes group (SOCMUE in its Spanish acronym) developed a protocol based on the usage of insulin in a basal-bolus regimen. This scientific society and several groups of experts recommend the usage of this protocol in the insulinisation of the hospitalized diabetic patient. However, the traditional treatment based on a sliding scale of rapid insulin depending on the blood sugar level after each main meal is still being used. OBJECTIVE: This intervention study intends to analyse and compare the effectiveness of the traditional treatment (ISS) instead of the protocol proposed by the SOCMUE using as reference population patients treated in the emergency services of the University Hospital Mutual of Terrassa. STUDY DESIGN AND METHODS: This intervention study will be conducted in a 3 month period. The first month the blood glucose control will be analysed with Insulin Sliding Scale therapy. The second month. The second month nurses and doctors will be trained in the use of basal bolus insulin (BBI) therapy in the emergency services. The last month the blood glucose control will be analysed again after using the BBI therapy. The sample selection will be conducted using a consecutive, non-probabilistic type model, in which all patients fulfilling the required criteria will be selected in a determined period of a month per group