Studying the efficacy of insulin sliding scale: Clinical pharmacy approach

Abstract

Over more than 40 years, many clinical studies are questioning the efficacy of Insulin Sliding Scale (ISS) in controlling blood sugar levels in hospitalized diabetic patients. Its efficacy remains suboptimal and many treatment guidelines recommending its discontinuation. No studies were conducted to explore the impact of clinical pharmacy services in this area. This study aimed to detect the efficacy of ISS in controlling blood sugar level and convince the physicians about ISS failure in an attempt to change to the Basal / Bolus technique. Methods: a total of 99 cardiovascular patients were enrolled in this study and during clinical pharmacist’s round, responses to the ISS were recorded and discussed with the treating physicians. The physician’s acceptance was also recorded. Specific patients’ characteristics that may potentially affect the blood sugar levels control were detected for every patient. Results: ISS failed to control the blood sugar level in 98% of the patients. Only 12% of patients had elevated serum creatinine. Elderly patients accounted for 49% of the patients and 54% of patients were obese. Physician’s response rate to change to the basal / bolus technique was 54%. Conclusion: ISS failure in controlling blood sugar levels necessitates its discontinuation.