Use of Sliding Scale Insulin: Investigating the use of sliding scale insulin (SSI) in managing hyperglycemia in emergency cases in the hospital, and comparing it with evidence-based approaches like basal-bolus insulin regimens

Objective: This clinical audit focuses on identifying and describing the pattern of Sliding Scale Insulin in the management of hyperglycemia in emergencies in Lady Reading Hospital, Peshawar. This study matches SSI to EB-BBI to determine which of the two produces more favorable patient outcomes such as glycaemic control, incidence of hypoglycaemia, hospital stay, and mortality. Pre-intervention and post-intervention were audited to determine the best practice to embrace after the cycling accord. Methods: A total of 456 patients who developed hyperglycemia during their admission were part of the audit. A pilot survey during the first audit cycle (from 1 Dec 2023 to 29 Feb 2024) assessed the implementation of SSI versus basal-bolus insulin regimens. After applying the intervention strategies to enhance the use of basal-bolus insulin among the patients a second audit (from March 1 2024 to June 15, 2024) was conducted. Information from patient characteristics such as age, sex, insulin treatment and dose, glycemic control measures, complications, hospitalization length and mortality rate of patients were gathered and analyzed between the two cycles. Results: In the first audit cycle, 68% of patients were managed with SSI to increased risk of hypoglycemia 28% and longer hospital stay of 6.2 days compared to patients with basal bolus insulin who experienced 12% of hypoglycemia and 4.5 days of hospital stay. Interventions were used to decrease the use of SSI down to 45 %; this was accompanied by better results; for instance, incidences of hypoglycaemia were recorded at 19 % while the average length of stay in hospital was 5.4 days. The results in basal-bolus insulin regimens were more favorable, though all compared regimens had similar or slightly reduced mortality rates. Conclusion: The audit showed that basal-bolus insulin management regimens provided better and superior glycemic control and better patient outcomes than SSI in emergency hyperglycemia situations. In the first instance, implementing basal-bolus insulin posed lessons in staff development and had limited sources; nonetheless, the study established enhanced patient safety and shortened length of stay. Specifically, this audit assists to validate basal-bolus regimens as the best approach of treating hyperglycemia in emergencies.