Physiologic Insulin Therapy for the Management of Hyperglycemia in the Hospital
Physiologic Insulin Therapy for the Management of Hyperglycemia in the Hospital
Many hospitals have begun giving insulin to nearly all patients with diabetes while they are
 in the hospital even if a patient does not use insulin at home. Controlling blood sugar with
 insulin when a patient is hospitalized is believed to reduce the risk of complications and
 death, but research has not demonstrated these benefits except in patients who are critically
 ill. The purpose of this study, therefore, is to evaluate whether such insulin therapy
 actually does reduce in-hospital complications, deaths, need for intensive care, or length of
 stay in the hospital.
The primary aim of the proposed study is to determine if physiologic insulin therapy
 administered to general hospital inpatients with hyperglycemia favorably affects in-hospital
 complications and mortality, need for intensive care, or length of stay. The secondary aim is
 to determine if the magnitude of benefit derived from this therapy differs (a) in patients
 with known vs. newly diagnosed diabetes, or (b) in medical vs. surgical patients. The study
 will analyze data from a natural experiment that occurred when the applicant institution
 introduced universal physiologic insulin therapy as the standard of care for hyperglycemia. A
 quasi-experimental before-and-after study will compare in-hospital complications, mortality,
 and resource use in patients with comorbid type 2 diabetes before vs. after implementation of
 this standard (n≈6400). Outcomes measured at 7 nearby acute-care teaching hospitals during
 the same two time intervals will provide parallel control data (n≈35,000). Data from the
 control hospitals will make it possible to evaluate whether temporal changes in patient
 characteristics or other variables affecting hospitals in the region could explain effects
 that might otherwise be erroneously attributed to the intervention. Given the high prevalence
 of comorbid diabetes in the hospital and the possibility that universal physiologic insulin
 for managing hyperglycemia may not deliver the intended benefit or could even do more harm
 than good, answering this question is an important goal.
Inclusion Criteria:

 -  Type 2 diabetes

 Exclusion Criteria:

 -  Pregnant

 -  Admitted directly to an intensive care unit

 -  Length of stay <2 days