Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery)

  1. Monica Rizzo, MD6
  1. 1Department of Medicine, Emory University, Atlanta, Georgia
  2. 2Division of Endocrinology, Grady Memorial Hospital, Atlanta, Georgia
  3. 3Division of Endocrinology, Emory University Hospital, Atlanta, Georgia
  4. 4Rollins School of Public Health, Emory University, Atlanta, Georgia
  5. 5Division of Endocrinology, Atlanta Veterans Administration Medical Center, Atlanta, Georgia
  6. 6Department of Surgery, Emory University, Atlanta, Georgia
  1. Corresponding author: Guillermo E. Umpierrez, geumpie{at}


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.


  • Received July 21, 2010.
  • Accepted October 21, 2010.

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  1. Diabetes Care vol. 34 no. 2 256-261
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