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Basal-Bolus Therapy Works Well for Type 2 Diabetics

Insulin levels of non-critical patients managed more successfully than with sliding-scale regular therapy

MONDAY, Sept. 17 (HealthDay News) -- Insulin levels of type 2 diabetic patients who are admitted to the hospital for non-critical illnesses can be more effectively managed when they are treated with basal-bolus insulin therapy instead of sliding-scale regular insulin therapy, according to the results of a randomized trial published in the September issue of Diabetes Care.

Guillermo Umpierrez, M.D., of the Emory University School of Medicine in Atlanta, and colleagues followed 130 insulin-naive patients with type 2 diabetes who had been admitted to two hospitals. Half the participants were treated with glargine and glulisine and half with sliding-scale regular insulin. The goal was to maintain fasting and premeal glucose levels of less than 140 mg/dL while avoiding hypoglycemia.

Sixty-six percent of the patients in the basal-bolus group achieved the target glucose level compared to 38 percent of the regular insulin group. Treatment with the regular insulin regimen was associated with a higher mean fasting glucose, mean random glucose, and mean glucose overall during the patients' hospital stay. Nine patients who failed to respond to the regular insulin regimen were switched to the basal-bolus regimen. In each case, glycemic control improved rapidly.

"Implementing standardized subcutaneous insulin order sets promoting the use of scheduled insulin therapy and discouraging the sole use of sliding-scale regular insulin are key interventions that might reduce complications associated with severe hyperglycemia and hypoglycemia in hospitalized patients," the authors conclude.

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