Insulin Therapy and Glycemic Control in Hospitalized Patients With Diabetes During Enteral Nutrition Therapy A randomized

OBJECTIVE — To compare two subcutaneous insulin strategies for glycemic management of hyperglycemia in non–critically ill hospitalized patients with diabetes during enteral nutrition therapy (ENT). RESEARCHDESIGNANDMETHODS — Fifty inpatients were prospectively random-ized to receive sliding-scale regular insulin (SSRI) alone (n 25) or in combination with insulin glargine (n 25). NPH insulin was added for persistent hyperglycemia in the SSRI group (glucose 10 mmol/l). RESULTS — Glycemic control was similar in the SSRI and glargine groups (mean SD study glucose 8.9 1.6 vs. 9.2 1.6 mmol/l, respectively; P 0.71). NPH insulin was added in 48% of the SSRI group subjects. There were no group differences in frequency of hypoglycemia (1.3 4.1 vs. 1.1 1.8%; P 0.35), total adverse events, or length of stay. CONCLUSIONS — Both insulin strategies (SSRI with the addition of NPH for persistent hyperglycemia and glargine) demonstrated similar efficacy and safety in non–critically ill hos-pitalized patients with type 2 diabetes during ENT. Diabetes Care 32:594–596, 2009 H yperglycemia is a commonly en-countered complication of inpa-tient enteral nutrition therapy (ENT) (1,2). In one study, 34 % of sub-jects receiving ENT experienced blood glucose levels11.1 mmol/l (2). This de-gree of hyperglycemia is associated with adverse patient outcomes and prolonged hospital length of stay (LOS) (3–5). Although several subcutaneous insu-lin regimens are proposed for managing patients during ENT in noncritical care units, there are no studies comparing these strategies (4). This results in the pre-scribing of insulin therapy according to clinician preference often without achiev-ing desired glycemic targets (6,7). The primary aim of this study was to compare the effect of administration of sliding-scale regular insulin (SSRI) alone with that of administration of insulin glargine in combination with SSRI on gly-cemic control, adverse events, and hospi-tal LOS during inpatient ENT. RESEARCH DESIGN AN