Basal-Bolus Regimen With Insulin Analogues Versus Human Insulin in Medical Patients with type 2 Diabetes: A Randomized Controlled Trial in Latin America

Bueno, E; Benitez, A; Rufinelli, Jazmín Vera; Figueredo, Rafael; Alsina, Shirley; Ojeda, A; Samudio, Sandra; Cáceres, M; Argüello, R; Romero, Fabiola; Echagüe, Gloria; Pasquel, Francisco J.; Umpiérrez, Guillermo E.

doi:10.4158/ep15675.or

Cited by 46 publications

(39 citation statements)

References 22 publications

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“…The results of several randomized controlled trials have shown that treatment with basal-bolus regimens with insulin analogs improves glycemic control and reduces the rate of hospital complications in patients with T2D compared to sliding-scale insulin regimens (9–11). In addition, the use of basal insulin analogs results in similar glycemic control but in lower rates of hypoglycemia in hospitalized patients with type 1 and type 2 diabetes compared to treatment with NPH (12, 23) and premixed insulin formulations (14). Based on these studies, the use of basal insulin analogs -glargine and detemir- has become the preferred insulin formulations in the hospital setting.…”

Section: Discussionmentioning

confidence: 99%

“…Several randomized controlled trials using subcutaneous basal-bolus insulin regimens have reported better glycemic control and reduction of complications with this approach compared to sliding-scale insulin in patients with type 2 diabetes (9–11). Insulin glargine and detemir are the most commonly used basal insulin formulations, and have been associated with lower glycemic variability and less severe hypoglycemia compared to neutral protamine hagedorn insulin (NPH) or premixed insulin formulations (12–14). …”

Section: Introductionmentioning

confidence: 99%

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Comparison of Efficacy and Safety of Glargine and Detemir Insulin in the Management of Inpatient Hyperglycemia and Diabetes

et al. 2017

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Objective Glargine and detemir insulin are the two most commonly prescribed basal insulin analogs for the ambulatory and inpatient management of diabetes. The efficacy and safety of basal insulin analogs in the hospital setting has not been established. Methods This observational study compared differences in glycemic control and outcomes in non-ICU patients with blood glucose (BG) >140 mg/dl who were treated with glargine or detemir, between 01/01/2012 and 09/30/2015 in two academic centers. Results Among 6,245 medical and surgical patients with hyperglycemia, 5,749 received ≥ 1 dose of glargine and 496 patients received detemir during the hospital stay. There were no differences in the mean daily BG (glargine 182±46 mg/dl and detemir 180±44 mg/dl, p=0.70). There were no differences in mortality, hospital complications, or readmissions between groups (all, p= NS). After adjusting for potential confounders, there was no statistically significant difference in hypoglycemia rates between treatment groups. Patients treated with detemir also required higher total daily basal insulin doses (0.27 ± 0.16 vs 0.22 ± 0.15 units/kg/day, p <0.001). Glargine-treated patients had statistically longer LOS, however this difference may not be clinically relevant [6.8 ± 7.4 vs 6.0 ± 6.3 days, p <0.001]. Conclusions Our study indicates that treatment with glargine and detemir resulted in similar inpatient glycemic control in general medicine and surgery patients. Detemir treatment was associated with higher daily basal insulin dose and number of injections. A prospective randomized study is needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Efficacy and Safety of Glargine and Detemir Insulin in the Management of Inpatient Hyperglycemia and Diabetes

et al. 2017

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“…In this population, basal–bolus treatment (glargine and glulisine or NPH and regular) also improved glycemic control compared with sliding-scale insulin [79, 80]. …”

Section: Module 4: Management Of Hyperglycemiamentioning

confidence: 99%

Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)

Bertoluci

Moreira

Faludi

et al. 2017

Diabetol Metab Syndr

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BackgroundSince the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical risk-based approach on treatment for patients with diabetes.Main bodyThe Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk; (2) a guide to statin use, including new definitions of LDL-cholesterol and in non-HDL-cholesterol targets; (3) evaluation of silent myocardial ischemia and subclinical atherosclerosis in patients with diabetes; (4) hypertension treatment; and (5) the use of antiplatelet therapy.ConclusionsDiabetes is a heterogeneous disease. Although cardiovascular risk is increased in most patients, those without risk factors or evidence of sub-clinical atherosclerosis are at a lower risk. Optimal management must rely on an approach that will cover both cardiovascular disease prevention in individuals in the highest risk as well as protection from overtreatment in those at lower risk. Thus, cardiovascular prevention strategies should be individualized according to cardiovascular risk while intensification of treatment should focus on those at higher risk.

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“…Regimens using insulin analogs and human insulin result in similar glycemic control in the hospital setting (30). The use of subcutaneous rapid-or short-acting insulin before meals or every 4-6 h if no meals are given or if the patient is receiving continuous enteral/ parenteral nutrition is indicated to correct hyperglycemia (2).…”

Section: Noncritical Care Settingmentioning

confidence: 99%

“…In such instances, POC glucose testing should be performed immediately before meals. If oral intake is poor, a safer procedure is to administer the rapid-acting insulin immediately after the patient eats or to count the carbohydrates and cover the amount ingested (30).…”

Section: Noncritical Care Settingmentioning

confidence: 99%

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

157

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Basal-Bolus Regimen With Insulin Analogues Versus Human Insulin in Medical Patients with type 2 Diabetes: A Randomized Controlled Trial in Latin America

Cited by 46 publications

References 22 publications

Comparison of Efficacy and Safety of Glargine and Detemir Insulin in the Management of Inpatient Hyperglycemia and Diabetes

Comparison of Efficacy and Safety of Glargine and Detemir Insulin in the Management of Inpatient Hyperglycemia and Diabetes

Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

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