Evidence Against use of Insulin Sliding Scales
Since the 1970s, the efficacy of insulin sliding scale has been questioned. In the last 50+ years there has not been a single study demonstrating benefits of using insulting sliding scales <1>. The following chart summarize landmark studies against insulin sliding scales that are often referenced in literature.
The studies summarized above are the best evidence on insulin sliding scales that we have to date. However, please keep in mind that these studies have many limitations. The following are general limitations with regards to the studies summarized above. Please consider them before applying the evidence to your patient. Please also remember that although these are not high quality studies, there is still absolutely no evidence to support the use of insulin sliding scale.
1) Only studied in inpatients
2) Excluded elderly, frail patients with multiple co-morbidities
3) None of the studies were double-blinded
4) Mostly open-labeled study
1) Only studied in inpatients
2) Excluded elderly, frail patients with multiple co-morbidities
3) None of the studies were double-blinded
4) Mostly open-labeled study
Literature Against Insulin Sliding Scales
All clinical trials and most clinical reviews and commentaries have concluded that SSI is an inappropriate method of managing blood glucose in patients with diabetes. If you are interested, please consider reading the following literatures on the use of insulin sliding scales.
- Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med 2007; 120: 563– 567
- Kitibachi AE, Nwenye E. Sliding-scale insulin: more evidence needed before final exit? Diabetes Care 2007;30:2409-2410
- Hirsch IB. Sliding scale insulin–time to stop sliding. JAMA 2009; 301: 213– 214
- Miller DB. Banning the sliding scale. Can J Diabetes 2011;35(4):340-343
- Hirch IB, Hirsch RF. Sliding scake or sliding scare: It’s all sliding nonsense. Diabetes Spectrum 2001;14(2):79-81
- Sawin CT. Action without benefit. The sliding scale of insulin use. Arch Intern Med. 1997;157:489.
- Gill G, MacFarlane I. Are sliding-scale insulin regimens a recipe for diabetic instability? Lancet 1997;349:1555
- Katz CM. How efficient is sliding-scale insulin therapy? Problems with a ‘cookbook’ approach in hospitalized patients. Postgrad Med 1991;89:46-8, 51-54, 57
- Baldwin D, Villanueva G, McNutt R, et al. Eliminating inpatient sliding-scale insulin: a reeducation project with medical house staff. Diabetes Care 2005;28:1008-1011
- MacMillan DR. The fallacy of insulin adjustment by the sliding scale.J Ky Med Assoc 1970;68:577-579
- Browning LA, Dumo P. Sliding-scale insulin: an antiquated approach to glycemic control in hospitalized patients. Am J Health Syst Pharm 2004; 61:1611-1614.
- Jain VV, Taksande B. Sliding scale insulin therapy-evidence based rebuke.J MGIMS 2008.13(2) 29-31
References:
- Miller DB. Banning the sliding scale. Can J Diabetes 2011;35(4):340-343.
- Queale WS, Seidler AJ, Brancati FL : Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med 1997; 157: 545– 552.
- Umpierrez GE, Smiley D, Zisman A, et al.Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care 2007; 30: 2181– 2186.
- Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care 2011; 34: 256-261.
- Roberts GW, Agullar-Loza N, Burt MG, et al. Basa-bolus versus sliding-scale insulin for inpatient glcaemic control: a clinical practice comparison.MJA 2012;196(4):266-269.