SUN-170 Inpatient Insulin Precision: Balancing Safety and Efficacy with Post-Meal Insulin Administration

Abstract M. George: None. M. Zilbermint: None. S. Sokolinsky: None. K. Batty: None. M. Motevalli: None. C. Stanback: None. E. Gonzales: None. C. Miller: None. L. Sequeira: None. A.P. Demidowich: None. Background: In many hospitals, as in the outpatient setting, rapid-acting nutritional insulin is commonly administered before the meal to effectively mitigate post-prandial hyperglycemia. However, this strategy may place inpatients at increased risk for hypoglycemia, as hospitalized patients do not always have adequate nutritional intake shortly after receiving insulin doses due to challenges with tolerance of meal intake and logistical barriers to accessing meals at predictable times. Objective: To evaluate whether implementation of a hospital-wide policy to deliver nutritional insulin post-prandially (after consumption of at least 50% of the meal), as compared to pre-prandially, is associated with reductions in hypoglycemia without compromising control of hyperglycemia or overall length of stay. Methods: This was a retrospective cohort study performed at a 232-bed community hospital, evaluating adult inpatients who received at least one dose of nutritional insulin. Patients were divided into three subgroups: Time Period 1 (pre-intervention, September 2018 to June 27, 2019), Time Period 2 (immediate post-intervention, July 2019 to February 2020), and Time Period 3 (distant post-intervention, September 2022 to August 2023). Outcomes of interest included proportion of patient-days with any hypoglycemia (glucose ≤ 70 mg/dL), moderate hypoglycemia (< 54 mg/dL), severe hypoglycemia (≤ 40 mg/dL), and severe hyperglycemia (≥ 300 mg/dL). Daily mean glucose level and length of stay (LOS) were also assessed. Chi-square, Mann-Whitney U and Kruskal-Wallis tests were used to compare differences between groups using GraphPad Prism 8.4.3 (GraphPad Software LLC, San Diego, CA). Results: The number of patient-days analyzed for the pre-intervention, immediate post-intervention, and distant post-intervention cohorts were 1948, 1751, and 3244 days, respectively. Patient age, BMI, sex distribution, and HbA1C% were similar across the three groups (p’s > 0.05). Rates of any hypoglycemia were significantly reduced (9.4% vs 8.9% vs 6.7%; p < 0.001), and rates of severe hypoglycemia trended towards significance (1.3% vs 1.1% vs 0.7%; p = 0.07). Average daily mean glucose increased slightly over time (194.6 ± 62.5 vs 196.8 ± 65.5 vs 199.3 ± 61.5 mg/dL; p = 0.003), but there were no significant differences between rates of severe hyperglycemia (27.4% vs 28.3% vs 29.5%; p = 0.27) or LOS (7.0 ± 6.5 vs 6.9 ± 7.0 vs 7.1 ± 6.9 days; p =0.74). Discussion: Implementing a hospital-wide shift to post-prandial nutritional insulin administration significantly reduced overall hypoglycemia rates among inpatients without a notable increase in severe hyperglycemia. This suggests a promising strategy for improving patient safety in managing blood glucose levels, prompting further investigation into potential impacts on patient experience and nursing responsibilities related to insulin delivery timing. Sunday, June 2, 2024