Treatment in Hospitalized Type 2 Diabetes Patients May Require Less Control

Type 2’s get better control with basal insulin and a correction before meals….

In a recent study, Dr. Guillermo Umpierrez of Emory University, Atlanta and colleagues analyzed 375 type 2 diabetic hospitalized patients. They were randomized into three groups 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, or sliding scale regular insulin.

When compared to the sliding scale group, the study showed that both basal bolus and basal plus groups showed significant improvement in mean blood glucose. Treatment failure was defined as having two consecutive blood glucose readings above 240mg/dL. Treatment failure was 0% in the basal bolus treatment group, 2% in the basal plus treatment group, and 19% in the sliding scale treatment group. Hypoglycemia was also looked at in the study (BG <70 mg/dL), it occurred in 16% of the basal bolus group, 13% of the basal plus group and 3% of the sliding scale group.

According to the investigators these results "indicate that basal insulin is necessary for stable glucose control in the hospital and that the basal plus approach is an effective alternative to the basal bolus regimen for the initial management of hyperglycemia in general medical and surgical patients with type 2 diabetes."

Dr. Umpierrez added, "The majority of patients in the hospital have reduced oral intake due to illness or surgery. In such patients, the use of a single dose of glargine insulin plus correction (supplements) with glulisine is an effective treatment for most patients. When patients are able to eat or if they experience persistent hyperglycemia they may be transitioned to the more complex basal bolus regimen."

Guillermo E. Umpierrez, MD. 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. Diabetes Care. 2013 Feb 22.