70/30 Insulin Algorithm Versus Sliding Scale Insulin

BACKGROUND: The medical literature supports the fact that sliding scale dosing of insulin is an ineffective means to control blood glucose concentrations. Despite this, many clinicians still use sliding scale insulin (SSI) regimens. A better tool for controlling hyperglycemia is clearly needed. OBJECTIVE: To compare the efficacy of an algorithm using 70/30 insulin with traditional SSI dosing for glycemic control in hospitalized patients with type 2 diabetes. METHODS: A prospective, cohort, comparative trial was conducted at a 644-bed, 2-hospital, regional referral health system. Patients were screened for enrollment based on orders received in the pharmacy for sliding scale dosing of insulin. Patients were treated either following an algorithm using 70/30 insulin twice daily or traditional SSI dosing as written by the prescribing physician. RESULTS: Twenty patients with type 2 diabetes were involved in this pilot trial: 10 were treated with the 70/30 insulin algorithm and 10 received a physician-determined traditional SSI regimen. Patients treated based on the 70/30 insulin algorithm achieved better glycemic control (p = 0.042). No difference between the groups was detected in the average number of insulin units administered, insulin injections, or days patients spent on their respective insulin regimens. CONCLUSIONS: Glycemic control with the 70/30 insulin algorithm was superior to traditional SSI dosing.