Sliding Scale Insulin Use Among Nursing Home Residents With Type 2 Diabetes

While there are guidelines set in place to discourage sliding scale insulin (SSI) use one week after an admittance to a nursing home (NH), researchers observed SSI prevalence in weeks 2 through 5.

Study authors conducted an observational study of nonhospice Veterans Affairs NH residents with type 2 diabetes who were admitted to a NH for at least 1 week from October 1, 2013 to June 30, 2017. Two other short-acting insulin regimens including fixed dose insulin (FDI) or correction dose insulin (CDI) were compared to the weekly prevalence of SSI from week 2 to week 12 post admission.

Researchers examined factors correlated with transitioning regimens by week 5 or stopping SSI use in residents still on SSI in week 2. Diabetes-related factors such as HbA₁c, long-acting insulin use, hypoglycemia, and hyperglycemia, demographics such as race/ethnicity, age, sex, and frailty-related factors like comorbidities, functional and cognitive impairment were included in the study.

According to study authors, 21% of the cohort was on SSI in week 2 while 8% was on FDI, and 7% was on CDI. In the cohort’s frail subgroups 18% with moderate-severe cognitive impairment was on SSI, 5% was on FDI, and 4% was on CDI. At week 12 there was an SSI prevalence decrease from 21% to 16%.

Researchers reported continuing SSI or transitioning to a non-SSI short-acting insulin regimen was linked more in diabetes-related factors than frailty-related factors. The most common method of administering short-acting insulin in NH residents is SSI, according to authors of the study.

“More research needs to be done to explore why sliding scale use persists weeks after NH admission and explore how we can replace this practice with safer, more effective, and less burdensome regimens,” concluded study authors.

Reference:
Lam K, Gan S, Nguyen B, Lee SJ. Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes. J Am Geriatr Soc. Published online March 31, 2022. doi:10.1111/jgs.17771