Bedtime sliding scale insulin is unnecessary for hospitalized patients with bedtime glucose < 300 mg/dL: A nudge-based quasi-experiment
Main finding · Use of less-aggressive sliding scaleResult — go to the resultIncrease in use 91 % 95 % CI 87 % to 95 %Authors' conclusion
These results show it is unnecessary to give rapid-acting bedtime insulin for glucoses <300 mg/dL. Further research should be conducted using changes in the order set as a way of conducting well-controlled trials at low cost with minimum disruption to usual clinical care.
Study context
- Population
- Hospitalized patients with an inpatient insulin order set
- Participants
- 458 patients
- Comparison
- New order set defaulting to bedtime rapid-acting insulin only for glucose ≥300 mg/dL vs prior order set encouraging bedtime rapid-acting insulin
- Outcome
- Ordering of the less-aggressive bedtime sliding scale and mean morning glucose
Methodological detailsnudge-based, order-set default change, approximately half of providers arbitrarily assigned to new order set
- Nudge-based
- Order-set default change
- Approximately half of providers arbitrarily assigned to new order set
Main finding
Use of less-aggressive sliding scale
Increase in use
91 %
95 % CI 87 % to 95 %
New order setvs Prior order set
increase in use 91 % (95 % CI 87 % to 95 %)
As reported in the abstract
Further findings
- Mean morning glucose decreased
- 16 mg/dL (95% CI −16 to −1.1 mg/dL, p = 0.035)
- The abstract does not state which group's glucose decreased
Original publication
Bedtime sliding scale insulin is unnecessary for hospitalized patients with bedtime glucose < 300 mg/dL: A nudge-based quasi-experiment. Diabetes Res Clin Pract. Published 22 August 2025. doi:10.
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