Sliding-scale insulin used for blood glucose control: A meta-analysis of randomized controlled trials

Yen Ying Lee, You Meei Lin, Wuan Jin Leu, Mei Yi Wu, Ju Huei Tseng, Meng Ting Hsu, Chia Shan Tsai, An-Tsz Hsieh, Ka Wai Tam

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background Sliding-scale insulin has been widely used in treating inpatient hyperglycemia. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the efficacy and possible adverse effects of sliding-scale insulin in hospitalized patients. Methods PubMed, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov registry were searched for studies published up to May 2015. Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size using random effects models. Results Eleven RCTs containing a total of 1322 patients were identified. Among eight studies in which the RISS was compared with other regimens, no significant difference was observed in the percentage of patients who achieved the mean blood glucose level between the two groups, which was determined according to the numbers of blood samples (RR: 2.84; 95% CI: 0.94 to 8.59) and patients (RR: 1.75; 95% CI: 0.86 to 3.55). The mean blood glucose level (weighted mean difference = 27.33, 95% CI: 14.74 to 39.92) and incidence of hyperglycemic events were significantly higher in the RISS group than in the non-sliding-scale group. No significant difference in the incidence of severe hypoglycemia and length of hospitalization between the groups was identified. Conclusions The overall results of the meta-analysis indicated that applying the RISS alone or in combination with other antidiabetic medications did not provide any benefits in blood glucose control, but was accompanied by an increased incidence of hyperglycemic events. Therefore, we suggest that the use of sliding-scale insulin be discontinued in hospitals.

Original languageEnglish
Pages (from-to)1183-1192
Number of pages10
JournalMetabolism: Clinical and Experimental
Volume64
Issue number9
DOIs
Publication statusPublished - Sep 1 2015

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Blood Glucose
Meta-Analysis
Randomized Controlled Trials
Insulin
Incidence
Hospitalization Insurance
Hypoglycemia
Hypoglycemic Agents
PubMed
Hyperglycemia
Libraries
Registries
Inpatients

Keywords

  • Diabetes
  • Hyperglycemia
  • Hypoglycemia
  • Meta-analysis
  • Sliding scale insulin

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Sliding-scale insulin used for blood glucose control : A meta-analysis of randomized controlled trials. / Lee, Yen Ying; Lin, You Meei; Leu, Wuan Jin; Wu, Mei Yi; Tseng, Ju Huei; Hsu, Meng Ting; Tsai, Chia Shan; Hsieh, An-Tsz; Tam, Ka Wai.

In: Metabolism: Clinical and Experimental, Vol. 64, No. 9, 01.09.2015, p. 1183-1192.

Research output: Contribution to journalArticle

Lee, Yen Ying ; Lin, You Meei ; Leu, Wuan Jin ; Wu, Mei Yi ; Tseng, Ju Huei ; Hsu, Meng Ting ; Tsai, Chia Shan ; Hsieh, An-Tsz ; Tam, Ka Wai. / Sliding-scale insulin used for blood glucose control : A meta-analysis of randomized controlled trials. In: Metabolism: Clinical and Experimental. 2015 ; Vol. 64, No. 9. pp. 1183-1192.
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abstract = "Background Sliding-scale insulin has been widely used in treating inpatient hyperglycemia. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the efficacy and possible adverse effects of sliding-scale insulin in hospitalized patients. Methods PubMed, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov registry were searched for studies published up to May 2015. Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size using random effects models. Results Eleven RCTs containing a total of 1322 patients were identified. Among eight studies in which the RISS was compared with other regimens, no significant difference was observed in the percentage of patients who achieved the mean blood glucose level between the two groups, which was determined according to the numbers of blood samples (RR: 2.84; 95{\%} CI: 0.94 to 8.59) and patients (RR: 1.75; 95{\%} CI: 0.86 to 3.55). The mean blood glucose level (weighted mean difference = 27.33, 95{\%} CI: 14.74 to 39.92) and incidence of hyperglycemic events were significantly higher in the RISS group than in the non-sliding-scale group. No significant difference in the incidence of severe hypoglycemia and length of hospitalization between the groups was identified. Conclusions The overall results of the meta-analysis indicated that applying the RISS alone or in combination with other antidiabetic medications did not provide any benefits in blood glucose control, but was accompanied by an increased incidence of hyperglycemic events. Therefore, we suggest that the use of sliding-scale insulin be discontinued in hospitals.",
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AU - Lee, Yen Ying

AU - Lin, You Meei

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AU - Wu, Mei Yi

AU - Tseng, Ju Huei

AU - Hsu, Meng Ting

AU - Tsai, Chia Shan

AU - Hsieh, An-Tsz

AU - Tam, Ka Wai

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N2 - Background Sliding-scale insulin has been widely used in treating inpatient hyperglycemia. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the efficacy and possible adverse effects of sliding-scale insulin in hospitalized patients. Methods PubMed, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov registry were searched for studies published up to May 2015. Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size using random effects models. Results Eleven RCTs containing a total of 1322 patients were identified. Among eight studies in which the RISS was compared with other regimens, no significant difference was observed in the percentage of patients who achieved the mean blood glucose level between the two groups, which was determined according to the numbers of blood samples (RR: 2.84; 95% CI: 0.94 to 8.59) and patients (RR: 1.75; 95% CI: 0.86 to 3.55). The mean blood glucose level (weighted mean difference = 27.33, 95% CI: 14.74 to 39.92) and incidence of hyperglycemic events were significantly higher in the RISS group than in the non-sliding-scale group. No significant difference in the incidence of severe hypoglycemia and length of hospitalization between the groups was identified. Conclusions The overall results of the meta-analysis indicated that applying the RISS alone or in combination with other antidiabetic medications did not provide any benefits in blood glucose control, but was accompanied by an increased incidence of hyperglycemic events. Therefore, we suggest that the use of sliding-scale insulin be discontinued in hospitals.

AB - Background Sliding-scale insulin has been widely used in treating inpatient hyperglycemia. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the efficacy and possible adverse effects of sliding-scale insulin in hospitalized patients. Methods PubMed, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov registry were searched for studies published up to May 2015. Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size using random effects models. Results Eleven RCTs containing a total of 1322 patients were identified. Among eight studies in which the RISS was compared with other regimens, no significant difference was observed in the percentage of patients who achieved the mean blood glucose level between the two groups, which was determined according to the numbers of blood samples (RR: 2.84; 95% CI: 0.94 to 8.59) and patients (RR: 1.75; 95% CI: 0.86 to 3.55). The mean blood glucose level (weighted mean difference = 27.33, 95% CI: 14.74 to 39.92) and incidence of hyperglycemic events were significantly higher in the RISS group than in the non-sliding-scale group. No significant difference in the incidence of severe hypoglycemia and length of hospitalization between the groups was identified. Conclusions The overall results of the meta-analysis indicated that applying the RISS alone or in combination with other antidiabetic medications did not provide any benefits in blood glucose control, but was accompanied by an increased incidence of hyperglycemic events. Therefore, we suggest that the use of sliding-scale insulin be discontinued in hospitals.

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