Mealtime Insulin Dosing by Carbohydrate Counting in Hospitalized Cardiology Patients: A Retrospective Cohort Study

Kristina M. Thurber, Ross A. Dierkhising, Sarah A. Reiland, Kristina K. Pearson, Steven A. Smith, John G. O'Meara

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Carbohydrate counting may improve glycemic control in hospitalized cardiology patients by providing individualized insulin doses tailored to meal consumption. The purpose of this study was to compare glycemic outcomes with mealtime insulin dosed by carbohydrate counting versus fixed dosing in the inpatient setting. Materials and Methods: This single-center retrospective cohort study included 225 adult medical cardiology patients who received mealtime, basal, and correction-scale insulin concurrently for at least 72 h and up to 7 days in the interval March 1, 2010-November 7, 2013. Mealtime insulin was dosed by carbohydrate counting or with fixed doses determined prior to meal intake. An inpatient diabetes consult service was responsible for insulin management. Exclusion criteria included receipt of an insulin infusion. The primary end point compared mean daily postprandial glucose values, whereas secondary end points included comparison of preprandial glucose values and mean daily rates of hypoglycemia. Results: Mean postprandial glucose level on Day 7 was 204 and 183 mg/dL in the carbohydrate counting and fixed mealtime dose groups, respectively (unadjusted P=0.04, adjusted P=0.12). There were no statistical differences between groups on Days 2-6. Greater rates of preprandial hypoglycemia were observed in the carbohydrate counting cohort on Day 5 (8.6% vs. 1.5%, P=0.02), Day 6 (1.7% vs. 0%, P=0.01), and Day 7 (7.1% vs. 0%, P=0.008). No differences in postprandial hypoglycemia were seen. Conclusions: Mealtime insulin dosing by carbohydrate counting was associated with similar glycemic outcomes as fixed mealtime insulin dosing, except for a greater incidence of preprandial hypoglycemia. Additional comparative studies that include hospital outcomes are needed.

Original languageEnglish (US)
Pages (from-to)15-21
Number of pages7
JournalDiabetes Technology and Therapeutics
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Cardiology
Meals
Cohort Studies
Retrospective Studies
Carbohydrates
Insulin
Hypoglycemia
Glucose
Inpatients
Incidence

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medical Laboratory Technology

Cite this

Thurber, K. M., Dierkhising, R. A., Reiland, S. A., Pearson, K. K., Smith, S. A., & O'Meara, J. G. (2016). Mealtime Insulin Dosing by Carbohydrate Counting in Hospitalized Cardiology Patients: A Retrospective Cohort Study. Diabetes Technology and Therapeutics, 18(1), 15-21. https://doi.org/10.1089/dia.2015.0103

Mealtime Insulin Dosing by Carbohydrate Counting in Hospitalized Cardiology Patients : A Retrospective Cohort Study. / Thurber, Kristina M.; Dierkhising, Ross A.; Reiland, Sarah A.; Pearson, Kristina K.; Smith, Steven A.; O'Meara, John G.

In: Diabetes Technology and Therapeutics, Vol. 18, No. 1, 01.01.2016, p. 15-21.

Research output: Contribution to journalArticle

Thurber, Kristina M. ; Dierkhising, Ross A. ; Reiland, Sarah A. ; Pearson, Kristina K. ; Smith, Steven A. ; O'Meara, John G. / Mealtime Insulin Dosing by Carbohydrate Counting in Hospitalized Cardiology Patients : A Retrospective Cohort Study. In: Diabetes Technology and Therapeutics. 2016 ; Vol. 18, No. 1. pp. 15-21.
@article{7676e65352d7449a84973e1570f5f640,
title = "Mealtime Insulin Dosing by Carbohydrate Counting in Hospitalized Cardiology Patients: A Retrospective Cohort Study",
abstract = "Background: Carbohydrate counting may improve glycemic control in hospitalized cardiology patients by providing individualized insulin doses tailored to meal consumption. The purpose of this study was to compare glycemic outcomes with mealtime insulin dosed by carbohydrate counting versus fixed dosing in the inpatient setting. Materials and Methods: This single-center retrospective cohort study included 225 adult medical cardiology patients who received mealtime, basal, and correction-scale insulin concurrently for at least 72 h and up to 7 days in the interval March 1, 2010-November 7, 2013. Mealtime insulin was dosed by carbohydrate counting or with fixed doses determined prior to meal intake. An inpatient diabetes consult service was responsible for insulin management. Exclusion criteria included receipt of an insulin infusion. The primary end point compared mean daily postprandial glucose values, whereas secondary end points included comparison of preprandial glucose values and mean daily rates of hypoglycemia. Results: Mean postprandial glucose level on Day 7 was 204 and 183 mg/dL in the carbohydrate counting and fixed mealtime dose groups, respectively (unadjusted P=0.04, adjusted P=0.12). There were no statistical differences between groups on Days 2-6. Greater rates of preprandial hypoglycemia were observed in the carbohydrate counting cohort on Day 5 (8.6{\%} vs. 1.5{\%}, P=0.02), Day 6 (1.7{\%} vs. 0{\%}, P=0.01), and Day 7 (7.1{\%} vs. 0{\%}, P=0.008). No differences in postprandial hypoglycemia were seen. Conclusions: Mealtime insulin dosing by carbohydrate counting was associated with similar glycemic outcomes as fixed mealtime insulin dosing, except for a greater incidence of preprandial hypoglycemia. Additional comparative studies that include hospital outcomes are needed.",
author = "Thurber, {Kristina M.} and Dierkhising, {Ross A.} and Reiland, {Sarah A.} and Pearson, {Kristina K.} and Smith, {Steven A.} and O'Meara, {John G.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1089/dia.2015.0103",
language = "English (US)",
volume = "18",
pages = "15--21",
journal = "Diabetes Technology and Therapeutics",
issn = "1520-9156",
publisher = "Mary Ann Liebert Inc.",
number = "1",

}

TY - JOUR

T1 - Mealtime Insulin Dosing by Carbohydrate Counting in Hospitalized Cardiology Patients

T2 - A Retrospective Cohort Study

AU - Thurber, Kristina M.

AU - Dierkhising, Ross A.

AU - Reiland, Sarah A.

AU - Pearson, Kristina K.

AU - Smith, Steven A.

AU - O'Meara, John G.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Carbohydrate counting may improve glycemic control in hospitalized cardiology patients by providing individualized insulin doses tailored to meal consumption. The purpose of this study was to compare glycemic outcomes with mealtime insulin dosed by carbohydrate counting versus fixed dosing in the inpatient setting. Materials and Methods: This single-center retrospective cohort study included 225 adult medical cardiology patients who received mealtime, basal, and correction-scale insulin concurrently for at least 72 h and up to 7 days in the interval March 1, 2010-November 7, 2013. Mealtime insulin was dosed by carbohydrate counting or with fixed doses determined prior to meal intake. An inpatient diabetes consult service was responsible for insulin management. Exclusion criteria included receipt of an insulin infusion. The primary end point compared mean daily postprandial glucose values, whereas secondary end points included comparison of preprandial glucose values and mean daily rates of hypoglycemia. Results: Mean postprandial glucose level on Day 7 was 204 and 183 mg/dL in the carbohydrate counting and fixed mealtime dose groups, respectively (unadjusted P=0.04, adjusted P=0.12). There were no statistical differences between groups on Days 2-6. Greater rates of preprandial hypoglycemia were observed in the carbohydrate counting cohort on Day 5 (8.6% vs. 1.5%, P=0.02), Day 6 (1.7% vs. 0%, P=0.01), and Day 7 (7.1% vs. 0%, P=0.008). No differences in postprandial hypoglycemia were seen. Conclusions: Mealtime insulin dosing by carbohydrate counting was associated with similar glycemic outcomes as fixed mealtime insulin dosing, except for a greater incidence of preprandial hypoglycemia. Additional comparative studies that include hospital outcomes are needed.

AB - Background: Carbohydrate counting may improve glycemic control in hospitalized cardiology patients by providing individualized insulin doses tailored to meal consumption. The purpose of this study was to compare glycemic outcomes with mealtime insulin dosed by carbohydrate counting versus fixed dosing in the inpatient setting. Materials and Methods: This single-center retrospective cohort study included 225 adult medical cardiology patients who received mealtime, basal, and correction-scale insulin concurrently for at least 72 h and up to 7 days in the interval March 1, 2010-November 7, 2013. Mealtime insulin was dosed by carbohydrate counting or with fixed doses determined prior to meal intake. An inpatient diabetes consult service was responsible for insulin management. Exclusion criteria included receipt of an insulin infusion. The primary end point compared mean daily postprandial glucose values, whereas secondary end points included comparison of preprandial glucose values and mean daily rates of hypoglycemia. Results: Mean postprandial glucose level on Day 7 was 204 and 183 mg/dL in the carbohydrate counting and fixed mealtime dose groups, respectively (unadjusted P=0.04, adjusted P=0.12). There were no statistical differences between groups on Days 2-6. Greater rates of preprandial hypoglycemia were observed in the carbohydrate counting cohort on Day 5 (8.6% vs. 1.5%, P=0.02), Day 6 (1.7% vs. 0%, P=0.01), and Day 7 (7.1% vs. 0%, P=0.008). No differences in postprandial hypoglycemia were seen. Conclusions: Mealtime insulin dosing by carbohydrate counting was associated with similar glycemic outcomes as fixed mealtime insulin dosing, except for a greater incidence of preprandial hypoglycemia. Additional comparative studies that include hospital outcomes are needed.

UR - http://www.scopus.com/inward/record.url?scp=84954423290&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84954423290&partnerID=8YFLogxK

U2 - 10.1089/dia.2015.0103

DO - 10.1089/dia.2015.0103

M3 - Article

C2 - 26230278

AN - SCOPUS:84954423290

VL - 18

SP - 15

EP - 21

JO - Diabetes Technology and Therapeutics

JF - Diabetes Technology and Therapeutics

SN - 1520-9156

IS - 1

ER -