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Comparison of basal insulin regimens on glycemic variability in non-critically ill patients with Type 2 Diabetes.
Endocr Pract. 2015 Aug 26;
Authors: Haw JS, Farrokhi F, Smiley D, Peng L, Reyes D, Newton C, Pasquel FJ, Vellanki P, Umpierrez GE
Abstract
OBJECTIVE: To evaluate the impact of different subcutaneous basal insulin regimens on glycemic variability (GV) and hospital complications in non-ICU patients with type 2 diabetes (T2D).
METHODS: This study is a post-hoc analysis of 279 general medicine and surgery patients treated with either 'Basal Bolus' insulin regimen, using glargine once daily and glulisine before meals or with 'Basal Plus' regimen, using glargine once daily plus correction doses of glulisine before meals for glucose >140 mg/dl. GV was calculated as mean delta daily glucose, mean standard deviation (SD), and mean amplitude of glycemic excursions (MAGE).
RESULTS: Treatment with Basal Bolus and Basal Plus regimens resulted in similar mean daily glucose, hypoglycemia, length of stay, and hospital complications (all, p=NS). There were no differences in GV between treatment groups by delta change (72.5±36 vs. 69.3±34 mg/dl), SD (38.5±18 vs. 37.1±16 mg/dl) and MAGE (67.5±34 vs. 66.1±39 mg/dl), all p=NS. Surgery patients treated with Basal Bolus had higher GV compared to those treated with Basal Plus (delta daily glucose and SD: p=0.02, MAGE: p=0.009), but no difference in GV was found between treatment groups in general medicine patients (p=NS). Patients with hypoglycemia events had higher GV compared to subjects without hypoglycemia (p <0.05), but no association was found between GV and hospital complications (p=NS).
CONCLUSION: Treating hospitalized, non-ICU diabetic patients with Basal Plus insulin regimen resulted in similar glucose control and glycemic variability compared to the standard Basal Bolus insulin regimen. Higher GV was not associated with hospital complications.
PMID: 26307899 [PubMed - as supplied by publisher]