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Basal-bolus insulin versus sliding-scale insulin for inpatient glycaemic control: a clinical practice comparison

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dc.contributor.authorRoberts, G.
dc.contributor.authorAguilar Loza, N.
dc.contributor.authorEsterman, A.J.
dc.contributor.authorBurt, M.
dc.contributor.authorStranks, S.N.
dc.date.issued2012
dc.descriptionLink to a related website: https://www.mja.com.au/system/files/issues/196_04_050312/rob10853_fm.pdf, Open Access via Unpaywall
dc.description.abstractObjective: To determine if the improvement in inpatient glycaemic control observed with basal–bolus insulin (BBI) over sliding-scale insulin (SSI) in the formal study setting translates to routine clinical conditions. Design, setting and patients: Cross-sectional study in which capillary blood glucose levels (BGLs) were prospectively measured four times daily for up to 8 days in 124 patients with type 2 diabetes admitted to a tertiary teaching hospital and treated with BBI between November 2008 and May 2010. Data from the BBI treatment group were compared with retrospective data from 96 patients treated with SSI between June 2001 and May 2006. Main outcome measures: Mean daily BGL; independent effect of insulin regimen on mean daily BGL. Results: Mean baseline BGL was not significantly different in patients receiving BBI and SSI (mean ± SD, 11.3 ± 4.1 v 10.6 ± 4.3 mmol/L; P = 0.23). After the first full day of therapy, mean daily BGL for patients receiving BBI was 1.6 ± 3.7 mmol/L lower than baseline BGL, and it remained 1.6–2.4 mmol/L lower than baseline throughout the study (P < 0.001). In contrast, there was no significant change in BGL for patients receiving SSI. Random effects regression analysis indicated that BBI was associated with a significantly lower mean daily BGL than SSI, independent of other variables (P < 0.001). The incidence of hypoglycaemia (BGL < 4 mmol/L) was significantly greater in patients receiving BBI than SSI (3.3% v 1.4%; P < 0.001), but there was no significant difference for severe hypoglycaemia (BGL < 2.8 mmol/L) (0.3 v 0.5%; P = 0.3). Conclusions: Under routine clinical conditions, BBI is effective and safe across a range of patients and appears to be superior to SSI. Clinical improvements reflected those seen in a strict formal study setting.
dc.identifier.citationMedical Journal of Australia, 2012; 196(4):266-269
dc.identifier.doi10.5694/mja11.10853
dc.identifier.issn0025-729X
dc.identifier.issn1326-5377
dc.identifier.orcidEsterman, A.J. [0000-0001-7324-9171]
dc.identifier.urihttps://hdl.handle.net/1959.8/122480
dc.language.isoen
dc.publisherAustralasian Medical Publishing Company
dc.relation.fundingSanofi-Aventis
dc.rightsCopyright 2012 Australasian Medical Publishing Company
dc.source.urihttps://doi.org/10.5694/mja11.10853
dc.subjectHumans
dc.subjectDiabetes Mellitus, Type 2
dc.subjectHyperglycemia
dc.subjectHypoglycemia
dc.subjectInsulin
dc.subjectInsulin, Long-Acting
dc.subjectBlood Glucose
dc.subjectPrognosis
dc.subjectTreatment Outcome
dc.subjectDrug Administration Schedule
dc.subjectPulse Therapy, Drug
dc.subjectRisk Assessment
dc.subjectProspective Studies
dc.subjectCross-Sectional Studies
dc.subjectDose-Response Relationship, Drug
dc.subjectAdult
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectInpatients
dc.subjectAustralia
dc.subjectFemale
dc.subjectMale
dc.subjectPractice Patterns, Physicians'
dc.titleBasal-bolus insulin versus sliding-scale insulin for inpatient glycaemic control: a clinical practice comparison
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9915909326901831

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