Differences in inpatient glycemic control and response to subcutaneous insulin therapy between medicine and surgery patients with type 2 diabetes.

Smiley D, Umpierrez GE, Hermayer K, Newton C, Jacobs S, Olson DE, Khan A, Rizzo M, Peng L, Reyes D, Cardona S, Fonseca V. Differences in inpatient glycemic control and response to subcutaneous insulin therapy between medicine and surgery patients with type 2 diabetes. Journal of diabetes and its complications. 2013 Nov 1; 27(6):637-41.

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Abstract:

OBJECTIVE: To determine differences in inpatient glycemic control and response to two different glargine-based insulin regimens in general medicine and surgery patients with type 2 diabetes (T2D). METHODS: This is a post-hoc analysis of a prospective, multicenter, randomized trial of 298 non-ICU medicine and surgery patients with T2D treated with Basal Bolus regimen with glargine once daily and glulisine before meals and with Basal Plus regimen with glargine once daily and supplemental doses of glulisine before meals for blood glucose (BG) > 140mg/dl. Major study outcomes included differences in mean daily BG, frequency of treatment failures (defined as > 2 consecutive BG > 240mg/dl or a mean daily BG > 240mg/dl), and hypoglycemia between the medicine and surgery cohorts. RESULTS: Patients treated with Basal Bolus or with Basal Plus experienced similar improvement in mean daily BG after 1st day of therapy (p = 0.16), number of treatment failures (p = 0.11) and hypoglycemic events (p = 0.50). Compared to surgery patients (n = 130), medicine patients (n = 168) had higher admission BG (p = 0.01) and HbA1c levels (p < 0.01); however, they had similar response to either treatment regimen without differences in mean daily BG after 1st day of therapy (p = 0.18), number of treatment failures (p = 0.58), daily insulin requirements (p = 0.36), or in the frequency of hypoglycemia (p = 0.79). CONCLUSION: The Basal Plus regimen with glargine once daily and correction doses with glulisine before meals resulted in similar glycemic control to basal bolus regimen. We observed no differences in response to either basal insulin regimen between medicine and surgery patients with type 2 diabetes.