Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery)
- Guillermo E. Umpierrez, MD1,2,
- Dawn Smiley, MD1,2,
- Sol Jacobs, MD1,3,
- Limin Peng, PHD4,
- Angel Temponi, MD1,2,
- Patrick Mulligan, BA1,3,
- Denise Umpierrez, BA1,2,
- Christopher Newton, MD1,2,
- Darin Olson, MD, PHD1,5 and
- Monica Rizzo, MD6
- 1Department of Medicine, Emory University, Atlanta, Georgia
- 2Division of Endocrinology, Grady Memorial Hospital, Atlanta, Georgia
- 3Division of Endocrinology, Emory University Hospital, Atlanta, Georgia
- 4Rollins School of Public Health, Emory University, Atlanta, Georgia
- 5Division of Endocrinology, Atlanta Veterans Administration Medical Center, Atlanta, Georgia
- 6Department of Surgery, Emory University, Atlanta, Georgia
- Corresponding author: Guillermo E. Umpierrez, .
OBJECTIVE The optimal treatment of hyperglycemia in general surgical patients with type 2 diabetes mellitus is not known.
RESEARCH DESIGN AND METHODS This randomized multicenter trial compared the safety and efficacy of a basal-bolus insulin regimen with glargine once daily and glulisine before meals (n = 104) to sliding scale regular insulin (SSI) four times daily (n = 107) in patients with type 2 diabetes mellitus undergoing general surgery. Outcomes included differences in daily blood glucose (BG) and a composite of postoperative complications including wound infection, pneumonia, bacteremia, and respiratory and acute renal failure.
RESULTS The mean daily glucose concentration after the 1st day of basal-bolus insulin and SSI was 145 ± 32 mg/dL and 172 ± 47 mg/dL, respectively (P < 0.01). Glucose readings <140 mg/dL were recorded in 55% of patients in basal-bolus and 31% in the SSI group (P < 0.001). There were reductions with basal-bolus as compared with SSI in the composite outcome [24.3 and 8.6%; odds ratio 3.39 (95% CI 1.50–7.65); P = 0.003]. Glucose <70 mg/dL was reported in 23.1% of patients in the basal-bolus group and 4.7% in the SSI group (P < 0.001), but there were no significant differences in the frequency of BG <40 mg/dL between groups (P = 0.057).
CONCLUSIONS Basal-bolus treatment with glargine once daily plus glulisine before meals improved glycemic control and reduced hospital complications compared with SSI in general surgery patients. Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the hospital management of general surgery patients with type 2 diabetes.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc10-1407/-/DC1.
Clinical trial reg. no. NCT00596687, clinicaltrials.gov.
- Received July 21, 2010.
- Accepted October 21, 2010.
- © 2011 by the American Diabetes Association.
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