Late Breaking Original Research
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction:
A previous study at Ascension Seton Hospital Network (ASHN) found a 1:1 dose conversion to insulin detemir 100 units/mL (iDet100) from insulin glargine 300 units/mL (iGlar300) increased the risk of hypoglycemia as compared to 1:1 conversion from insulin glargine 100 units/mL. No studies have evaluated an automatic 20% dose reduction on therapeutic interchange from iGlar300 to iDet100.
Research Question or Hypothesis: Is there less hypoglycemia following implementation of a 20% dose reduction protocol from iGlar300 to inpatient iDet100?
Study Design: Multi-center, retrospective, chart-review comparing hypoglycemia before and after a 20% dose reduction was implemented within ASHN.
Methods: This study was a before/after study evaluating impact of ASHN protocol implemented in April 2021 requiring a minimum 20% reduction from home iGlar300 to inpatient iDet100. Previously, a 1:1 interchange was standard. Patients admitted between May 2019 and December 2022 were included if one dose of iDet100 was received following interchange from iGlar300. The primary endpoint was hypoglycemia incidence before and after protocol implementation. Secondary endpoints include time to first hypoglycemia and number of doses given before hypoglycemia. Logistic regression analyzed the relationship between percent interchange from home dose and hypoglycemia rate. Statistical analyses conducted with JMP Pro16.
Results: 284 patients were included: 128 in the pre-protocol and 156 in the post-protocol arm. The incidence of hypoglycemia was significantly less in the post-protocol arm than pre-protocol (11.7% vs. 24.7%; p=0.014). Median time to first hypoglycemia was significantly shorter in the pre-protocol arm (19 vs. 13 hours, p=0.041). For each percent reduction from iGlar300 to iDet100, the likelihood of hypoglycemia was reduced by 33% (OR=0.33; 95% CI [0.11-0.97]).
Conclusion: A protocol requiring a minimum 20% dose reduction from iGlar300 to inpatient iDet100 reduced hypoglycemia. Hospitals should consider adopting a similar policy to reduce hypoglycemia upon interchange.
Presenting Author
Brittany Glowacki BSAUniversity of Texas at Austin College of Pharmacy
Authors
Janci Addison PharmD, BCPS
Ascension Seton Network
Denise Kelley PharmD, BCPS
Ascension Seton Medical Center Austin
Kristin Janzen PharmD, BCPS
The University of Texas at Austin College of Pharmacy
Steven Wulfe PharmD
University of Texas at Austin College