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, MD1⇑,
- Dawn Smiley, MD1,
- Kathie Hermayer, MD2,
- Amna Khan, MD3,
- Darin E. Olson, MD, PHD1,4,
- Christopher Newton, MD1,
- Sol Jacobs, MD1,
- Monica Rizzo, MD5,
- Limin Peng, PHD6,
- David Reyes, MD1,
- Ingrid Pinzon, MD1,
- Maria Eugenia Fereira, MD1,
- Vicky Hunt, BA2,
- Ashwini Gore, MD2,
- Marcos T. Toyoshima, MD1 and
- Vivian A. Fonseca, MD3
- 1Department of Medicine, Division of Endocrinology, Emory University, Atlanta, Georgia
- 2Department of Medicine, Division of Endocrinology, Medical University of South Carolina, Charleston, South Carolina
- 3Department of Medicine, Division of Endocrinology, Tulane Medical Center, New Orleans, Louisiana
- 4Atlanta Veterans Affairs Medical Center, Decatur, Georgia
- 5Department of Surgery, Emory University, Atlanta, Georgia
- 6Rollins School of Public Health, Emory University, Atlanta, Georgia
- Corresponding author: Guillermo E. Umpierrez, .
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.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc12-1988/-/DC1.
- Received September 27, 2012.
- Accepted January 11, 2013.
- © 2013 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.