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

• Type of Material: Article
• Authors: Guillermo Umpierrez, Emory University; Dawn Smiley, Emory University; Kathie Hermayer, Medical University of South Carolina; Amna Khan, Tulane Medical Center; Darin Olson, Emory University; Christopher Newton, Emory University; Sol Jacobs, Emory University; Monica Rizzo, Emory University; Limin Peng, Emory University; David Reyes, Emory University; Ingrid Pinzon, Emory University; Maria Eugenia Fereira, Emory University; Vicky Hunt, Medical University of South Carolina; Ashwini Gore, Medical University of South Carolina; Marcos T. Toyoshima, Emory University; Vivian A. Fonseca, Tulane Medical Center
• Language: English
• Date: 2013-08
• Publisher: American Diabetes Association
• Publication Version: Final Published Version
• Copyright Statement: © 2013 by the American Diabetes Association
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://care.diabetesjournals.org/content/36/8/2169
• Title of Journal or Parent Work: Diabetes Care
• ISSN: 0149-5992
• Volume: 36
• Issue: 8
• Start Page: 2169
• End Page: 2174
• Grant/Funding Information: This investigator-initiated study was supported by an unrestricted grant from Sanofi (Bridgewater, NJ).; G.E.U. is supported in part by research grants from the American Diabetes Association (7-03-CR-35) and by PHS Grant UL1 RR025008 from the Clinical and Translational Science Award program, National Institutes of Health, National Center for Research Resources.; The sponsors of the study were not involved in the study design, data collection, analysis or interpretation of the results, or preparation of the manuscript.
• Keywords: Life Sciences & Biomedicine; Endocrinology & Metabolism; Science & Technology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

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 = 0.76). CONCLUSIONS The 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.