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Basal bolus insulin bested SSI therapy in surgery patients with type 2 diabetes
Umpierrez GE. Diabetes Care. 2011;34:256-261.
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When compared with sliding scale regular insulin, basal bolus treatment with insulin glargine plus insulin glulisine appeared superior in boosting glycemic control and decreasing complications in general surgery patients with type 2 diabetes.
As part of the Randomized Study of Basal Bolus Insulin Therapy in the Inpatient Management of Patients with Type 2 Diabetes (RABBIT 2 Surgery) trial, researchers compared the safety and efficacy of a basal bolus regimen involving once-daily administration of insulin glargine (Lantus, Sanofi-Aventis) plus premeal insulin glulisine (Apidra, Sanofi-Aventis) with sliding scale regular insulin (SSI) administered four times daily in general surgery patients with type 2 diabetes. Of 234 patients, they randomly assigned 104 to receive basal bolus treatment and 107 to receive SSI. The researchers excluded the remainder for various reasons.
Patients on the basal bolus regimen demonstrated better glycemic control than those using SSI, according to the results. After 1 day of therapy, the mean blood glucose level for these patients was 145 mg/dL compared with 172 mg/dL in the SSI group (P<.01). Further, 55% of patients in the basal bolus arm had glucose readings of less than 140 mg/dL vs. 31% of those receiving SSI (P<.001).
More patients in the basal bolus group also experienced hypoglycemia compared with the SSI group (23.1% vs. 4.7%; P<.001), although the incidence of severe hypoglycemia did not differ significantly between study arms.
Additionally, at 24.3%, complications such as wound infection, pneumonia, bacteremia, respiratory failure and acute renal failure occurred more frequently in the SSI group compared with 8.6% in patients on the basal bolus regimen (OR=3.39; 95% CI, 1.5-7.65).
“In summary, basal bolus insulin with glargine once daily plus glulisine before meals represents a simple and an effective regimen for the management of general surgery patients with type 2 diabetes,” the researchers said.
Disclosure: The researchers report no relevant financial disclosures.
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