Official websites use .gov

A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS

A lock ( 🔒 ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Need Help

Physiologic Insulin Therapy for the Management of Hyperglycemia in the Hospital

Award Number: R18DK104110
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)
PERIOD OF PERFORMANCE START DATE: 07/03/2015
PERIOD OF PERFORMANCE END DATE: 06/30/2018

Group Awards By:

View Award Description

Physiologic Insulin Therapy for the Management of Hyperglycemia in the Hospital - ¿ DESCRIPTION (provided by applicant): More than 30% of general hospital inpatients experience episodes of hyperglycemia. These individuals suffer more in-hospital complications, longer stays, and higher treatment costs. To prevent these adverse effects, many hospitals, including the applicant institution, have introduced physiologic insulin treatment protocols (also referred to as "basal-bolus therapy") intended to maintain blood glucose within a specified range. Physiologic insulin therapy includes multiple daily injections to cover insulin needs: basal (overnight fasting and between-meal), prandial (glucose excursions above basal at mealtime), and correction (supplemental insulin, as needed to correct hyperglycemia). Current national guidelines recommend physiologic insulin- and discourage a traditional sliding scale regimen (correction component only) or oral agents-but the guidelines note that beneficial effects of the therapy on clinical outcomes and hospital resource use have not been proven in the general inpatient setting. A recent systematic review of the pertinent literature came to the same conclusion, emphasizing the need for further research before routinely incorporating intensive forms of glycemic control in a general inpatient population. Since strategies to control hyperglycemia lead to potentially dangerous episodes of hypoglycemia in 1 of every 12 inpatients, sometimes causing seizures, coma, brain injury, or death in severe cases, it is critically important to demonstrate the benefits of this approach before accepting it as a hospital wide standard of care. The primary aim of the proposed study is to determine if physiologic insulin therapy administered to general hospital in patients 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.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2019 ( Subtotal = $0 )
2019	2016	NYU WINTHROP HOSPITAL	259 FIRST ST	MINEOLA	NY	11501	NASSAU	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	11/14/2018	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2016 ( Subtotal = $276,573 )
2016	2016	WINTHROP-UNIVERSITY HOSPITAL	259 1ST STREET	MINEOLA	NY	11501	NASSAU	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	5/25/2016	NON-COMPETING CONTINUATION	$276,573
														Subtotal = $276,573

Issue Date FY: 2015 ( Subtotal = $282,850 )
2015	2015	WINTHROP-UNIVERSITY HOSPITAL	259 1ST STREET	MINEOLA	NY	11501	NASSAU	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	7/3/2015	NEW	$282,850
														Subtotal = $282,850

Grand Total All Awards = $559,423

Top

All Categories

About

Search

Reports

Data Submission

Award Information

Physiologic Insulin Therapy for the Management of Hyperglycemia in the Hospital

Award Number: R18DK104110

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)

PERIOD OF PERFORMANCE START DATE: 07/03/2015

PERIOD OF PERFORMANCE END DATE: 06/30/2018

Federal Websites

Department of Health & Human Services

HHS Operating Divisions

HHS Staff Divisions

Download A Document Viewer