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In their recent study of the effects of sliding scale insulin use on rates of hyperglycemia in hospitalized patients, Queale et al¹ found no less hyperglycemia in patients using sliding scale regimens than in those not treated with sliding scale regimens. In an accompanying editorial, Sawin then concluded that sliding scales "offer no benefit to sick patients with diabetes."²

Two issues deserve comment. First, the observational nature of the study represents a significant source of potential bias. Patients who were not treated with sliding scale regimens very likely had less severe diabetes and so were at a lower risk for hyperglycemia. Second, the study had very low power to detect a benefit for sliding scale insulin use. Although "aggressive" sliding scale regimens were associated with approximately 50% less hyperglycemia than "conservative" sliding scale regimens, this finding fell short of statistical significance.

While improvements certainly could be made in the usual . . . [Full Text of this Article]

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