Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes

摘要

Objective: We sought to study the optimal management of hyperglycemia in non– intensive care unit patients with type 2 diabetes, as few studies so far have focused on this subject. Materials & Methods: We conducted a retrospective study to compare the efficacy and safety of a basal-bolus insulin regimen with that of sliding-scale regular insulin (SSI) in patients with type 2 diabetes. A total of 104 patients were included in this study. Results: Patients treated with basal insulin regimen had better glycemic control than those treated with SSI. The mean hospital length of stay was shorter in patients treated with basal-bolus as compared to the SSI-treated group. The mean glucose concentration during the last day of hospitalization was significantly higher in patients treated with SSI compared with those treated with the basal-bolus regimen At the same time, mean daily dose of insulin was significantly higher in the basal-bolus regimen compared with that in the SSI treatment group. Conclusion: Treatment with basal bolus insulin regimen resulted in significant improvement in glycemic control compared with that achieved with the use of SSI alone. Our study indicates that a basal-bolus insulin regimen should be preferred over SSI in the management of non– critically ill, hospitalized patients with type 2 diabetes. Introduction Hyperglycemia in hospitalized patients is a common, serious, and costly health care problem with profound medical consequences. Extensive evidence from observational studies indicates that in hospitalized patients with critical illness, hyperglycemia is associated with an increased risk of complications and mortality1-7. Many Clinical randomized trials in hospitalized patients have shown that intensive glucose control reduces the risk of multi-organ failure, systemic infections, and short- and long- term mortality. Effective management of hyperglycemia is also associated with a decreased length of intensive care unit and hospitalstay8. In patients, the presence of hyperglycemia has been associated with prolonged hospital stay, multiple infections, increased disability after hospital discharge, and death 9.More recently, studies in patients with community-acquired pneumonia reported that hyperglycemia was associated with increased risk of in- hospital complications and mortality 10, 11.Insulin, given either intravenously as a continuous infusion or subcutaneously, is the most effective agent for immediate control of hyperglycemia in the hospital. In the critical care setting, a variety of continuous insulin infusion protocols have been shown to be effective in achieving glycemic control, with a low rate of hypoglycemic events, and in improving hospital outcomes 12. In general medicine, however, hyperglycemia is frequently overlooked and inadequately addressed. Several reports from academic institutions have shown that most patients are treated with SSI and basal insulin is prescribed in less than one-half of patients 13, 14. Few clinical trials have focused on the optimal management of inpatient hyperglycemia in the noncritical setting.Accordingly, we conducted this retrospective study to compare the efficacy and safety of a basal-bolus insulin regimen with that of SSI in patients with type 2 diabetes admitted to general medicine wards. Materials and Methods All consecutive patients treated with SSI or basal bolus regimen from July 1, 2009, through January 1, 2010, were evaluated retrospectively with a thorough review of the medical records.Inclusion criteria: Age 18 years or more; Minimum 3-day length of stay; At least 2 blood glucose measurements greater than 150 mg/dL within the first 48 hours of admission; No admission to a critical care unit anytime during the hospital stay; and Receipt of nothing by mouth as well as no parenteral/enteral nutrition. Exclusion criteria: SSI patients who received oral hypoglycemics, insulin aspart mix, insulin detemir, insulin glargine, insulin glulisine, insulin NPH, or i