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

Guillermo E Umpierrez, Dawn Smiley, Kathie Hermayer, Amna Khan, Darin E Olson, Christopher Newton, Sol Jacobs, Monica Rizzo, Limin Peng, David Reyes, Ingrid Pinzon, Maria Eugenia Fereira, Vicky Hunt, Ashwini Gore, Marcos T Toyoshima, Vivian A Fonseca, Guillermo E Umpierrez, Dawn Smiley, Kathie Hermayer, Amna Khan, Darin E Olson, Christopher Newton, Sol Jacobs, Monica Rizzo, Limin Peng, David Reyes, Ingrid Pinzon, Maria Eugenia Fereira, Vicky Hunt, Ashwini Gore, Marcos T Toyoshima, Vivian A Fonseca

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.

Trial registration: ClinicalTrials.gov NCT00979628.

Figures

Figure 1
Figure 1
Differences in glycemic control in medical and surgical patients with T2D treated with basal-bolus (●) and basal plus (○) regimens. A: Mean daily BG levels. B: Mean BG levels before meals and bedtime.

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Source: PubMed

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