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

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

Basal Plus Trial

 

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 thefirst 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-bolusregimen in general medical and surgical patients with T2D.

 

BIBLIOGRAFIA

Umpierrez, GE.   Randomized Study Comparing a Basal-Bolus With a Basal Plus CorrectionnInsulin Regimen for the Hospital Management of Medical and Surgical Patients With Type 2 Diabetes. Diabetes Care36:2169–2174, 2013.