Flory, James H., Vertosick, Emily Ann, Kuperman, Gilad J., Ancker, Jessica S., Kim, Scott Y.H., Fitzpatrick, Christine, Gould, Kimberly, Weiss, Everett, & Vickers, Andrew J. (2025). Bedtime sliding scale insulin is unnecessary for hospitalized patients with bedtime glucose < 300 mg/dL: A nudge-based quasi-experiment.Diabetes Research and Clinical Practice, 228, 112428. https://doi.org/10.1016/j.diabres.2025.112428
This study looked at how bedtime rapid-acting insulin is used in hospitalized patients with moderately high blood sugar, particularly in populations like cancer patients where previous research may not apply. Researchers changed the standard insulin order so that rapid-acting insulin at bedtime would only be automatically suggested for glucose levels of 300 mg/dL or higher. About half of the providers used this new order set over a two-month period, allowing comparison with the original approach. Among 458 patients, the new order set led to a 91% increase in the use of a less-aggressive insulin plan and lowered average morning glucose by 16 mg/dL. These findings suggest that rapid-acting bedtime insulin is not needed for glucose levels below 300 mg/dL and highlight that simple changes to order sets can be used to run effective, low-cost clinical trials without disrupting usual patient care.
Fig. 1 Study schema.