OBJECTIVEEffective 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 METHODSThis 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).RESULTSImprovement 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 = 0.76).CONCLUSIONSThe use of a basal plus regimen with glargine once daily plus corrective 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.

Type 2 diabetes mellitus (T2DM) has been described as a new epidemic. Approximately 285 million people worldwide suffer from diabetes, and this number is predicted to increase by about 50% by year 2030.This article will review oral health manifestations of diabetes, and discuss associations between periodontal disease and diabetes. Although there is a strong body of evidence that supports the relationship between oral health and T2DM, oral health awareness is lacking among patients with diabetes and other health professionals. There is a need for the treating physician to be educated about the various oral manifestations of diabetes so that they can be diagnosed early and timely referrals to oral health specialists can be made. The established link between periodontitis and diabetes calls for an increased need to study ways to control both diseases, particularly among populations with health disparities and limited access to oral and health care.

Objective: The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke inIntracranial Stenosis (SAMMPRIS) study is the first stroke prevention trial to include protocoldriven intensive management of multiple risk factors. In this prespecified analysis, we aimed to investigate the relationship between risk factor control during follow-up and outcome of patients in the medical arm of SAMMPRIS.Methods: Data from SAMMPRIS participants in the medical arm (n 5 227) were analyzed. Risk factors were recorded at baseline, 30 days, 4 months, and then every 4 months for a mean followup of 32 months. For each patient, values for all risk factor measures were averaged and dichotomized as in or out of target.Results: Participants who were out of target for systolic blood pressure and physical activity, as well as those with higher mean low-density lipoprotein cholesterol and non-high-density lipoprotein, were more likely to have a recurrent vascular event (stroke, myocardial infarction, or vascular death) at 3 years compared to those who had good risk factor control. In the multivariable analysis, greater physical activity decreased the likelihood of a recurrent stroke, myocardial infarction, or vascular death (odds ratio 0.6, confidence interval 0.4-0.8).Conclusions: Raised blood pressure, cholesterol, and physical inactivity should be aggressively treated in patients with intracranial atherosclerosis to prevent future vascular events. Physical activity, which has not received attention in stroke prevention trials, was the strongest predictor of a good outcome in the medical arm in SAMMPRIS.ClinicalTrials.gov identifier: NCT00576693. Neurology ® 2017;88:379-385 GLOSSARY BMI 5 body mass index; BP 5 blood pressure; CI 5 confidence interval; HbA1c 5 hemoglobin A1c; HDL-C 5 high-density lipoprotein cholesterol; ICAS 5 intracranial atherosclerotic stenosis; LDL-C 5 low-density lipoprotein cholesterol; MI 5 myocardial infarction; mRS 5 modified Rankin Scale score; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio; PACE 5 Physician-based Assessment and Counseling for Exercise; SAMMPRIS 5 Stenting and Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis; SBP 5 systolic blood pressure; WASID 5 Warfarin Aspirin Symptomatic Intracranial Disease.