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- Title
Randomized Study Comparing a Basal-BolusWith a Basal Plus Correction Insulin Regimen for the Hospital Management ofMedical and Surgical PatientsWith Type 2 Diabetes.
- Authors
UMPIERREZ, GUILLERMO E.; SMILEY, DAWN; HERMAYER, KATHIE; KHAN, AMNA; OLSON, DARIN E.; NEWTON, CHRISTOPHER; JACOBS, SOL; RIZZO, MONICA; PENG, LIMIN; REYES, DAVID; PINZON, INGRID; FEREIRA, MARIA EUGENIA; HUNT, VICKY; GORE, ASHWINI; TOYOSHIMA, MARCOS T.; FONSECA, VIVIAN A.
- Abstract
OBJECTIVE -- Effective and easily implemented insulin regimens are needed to facilitate hospital glycemic control in general medical and surgical patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS -- This multicenter trial randomized 375 patients with T2D treated with diet, oral antidiabetic agents, or low-dose insulin (≤0.4 units/kg/day) to receive a basal-bolus regimen with glargine once daily and glulisine before meals, a basal plus regimen with glargine once daily and supplemental doses of glulisine, and sliding scale regular insulin (SSI). RESULTS -- Improvement in mean daily blood glucose (BG) after the first day of therapy was similar between basal-bolus and basal plus groups (P = 0.16), and both regimens resulted in a lower mean daily BG than did SSI (P = 0.04). In addition, treatment with basal-bolus and basal plus regimens resulted in less treatment failure (defined as > 2 consecutive BG > 240 mg/dL or a mean daily BG > 240 mg/dL) than did treatment with SSI (0 vs. 2 vs. 19%, respectively; P < 0.001). A BG > 70 mg/dL occurred in 16% of patients in the basal-bolus group, 13% in the basal plus group, and 3% in the SSI group (P = 0.02). There was no difference among the groups in the frequency of severe hypoglycemia (,40 mg/dL; P =0 . 7 6 ) . CONCLUSIONS -- The use of a basal plus regimen with glargine once daily plus corrective d doses with glulisine insulin before meals resulted in glycemic control similar to a standard basal-bolus regimen. The basal plus approach is an effective alternative to the use of a basal-bolus regimen in general medical and surgical patients with T2D.
- Subjects
INSULIN research; DIABETES; BLOOD sugar; HYPERGLYCEMIA; HOSPITAL care
- Publication
Diabetes Care, 2013, Vol 36, Issue 8, p2169
- ISSN
0149-5992
- Publication type
Article
- DOI
10.2337/dc12-1988