Hyperglycemia, Diabetes Treatments Are Safe, Effective for Hospital Use

The basal insulin analogues glargine and detemir are safe and effective, and provide similar benefits for glycemic control, among general medical and surgical patients with diabetes or hyperglycemia in the hospital setting, according to a recent study. 

Glargine and detemir insulin are the most commonly prescribed basal insulin analogues for the management of diabetes in the ambulatory and inpatient settings. However, little is known about the safety and efficacy of basal insulin analogues in the hospital setting.
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For their study, the researchers evaluated 6245 medical and surgical patients with hyperglycemia from January 1, 2012, to September 20, 2015. All patients included in the study had a blood glucose (BG) level above 140 mg/dL, and none had been admitted to the intensive care unit (ICU). During their hospital stay, patients were administered either 1 or more doses of glargine (n = 5749) or detemir (n = 496).

Results indicated that there were no differences between groups in the mean daily BG, rates of mortality, hospital complications, or re-admissions. After adjusting for confounders, the researchers noted no statistically significant difference between groups in the incidence of hypoglycemia.

The detemir group had required higher total doses of basal insulin per day (0.27 units/kg/day) compared with the glargine group (0.22 units/kg/day). Although patients on glargine had statistically longer lengths of stay while hospitalized (6.8 days) compared with patients on detemir (7.4 days), this difference may not be clinically relevant.

“Our study indicates that treatment with glargine and detemir results in similar inpatient glycemic control in general medicine and surgery patients,” the researchers concluded. “Detemir treatment was associated with higher daily basal insulin dose and number of injections. A prospective randomized study is needed to confirm these findings.”

—Christina Vogt

Reference:

Galindo RJ, Davis GM, Fayfman M, et al. Comparison of efficacy and safety of glargine and detemir insulin in the management of inpatient hyperglycemia and diabetes. Endocr Pract. 2017;23(9). https://doi.org/10.4158/EP171804.OR.