Randomized Study Comparing a Basal-Bolus With a Basal Plus Correction Insulin Regimen for the Hospital Management of Medical and Surgical Patients With Type 2 Diabetes

Abstract

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.

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

“…In noncardiac general surgery patients, basal insulin plus premeal regular or short-acting insulin (basal-bolus) coverage has been associated with improved glycemic control and lower rates of perioperative complications compared with the traditional sliding scale regimen (regular or short-acting insulin coverage only with no basal dosing) (31,64).…”

13. Diabetes Care in the Hospital

“…A basal plus correction insulin regimen is the preferred treatment for patients with poor oral intake or those who are taking nothing by mouth (NPO) (13). An insulin regimen with basal, nutritional, and correction components (basal-bolus) is the preferred treatment for patients with good nutritional intake (10).…”

“…In general surgery (noncardiac) patients, basal insulin plus premeal regular or short-acting insulin (basal-bolus) coverage has been associated with improved glycemic control and lower rates of perioperative complications compared with the traditional sliding scale regimen (regular or short-acting insulin coverage only with no basal dosing) (13,14).…”

Sliding-scale insulin used for blood glucose control: a meta-analysis of randomized controlled trials

“…Of these studies, one study evaluated approaches to glucose management for diabetic patients who had undergone cardiopulmonary bypass; 4 were study protocols, 13 investigated the efficacy and safety of using the insulin regimens other than sliding scale; 4 studied the effects of the RISS, but no glycemic control outcomes provided; and 77 compared the outcomes of RISS and non-sliding-scale regimens, but were not randomized. Thus, the final number of eligible studies was 11 [4][5][6][7][8][9][10][25][26][27][28].…”