title: Insulin glargine dosing before next-day surgery: comparing three strategies.
abstract: OBJECTIVE
  To evaluate three evening insulin glargine dosing strategies for achievement of target (100-179 mg/dL; 5.5 - 9.8 mmol/L) and widened (80-249 mg/dL; 4.4 - 13.7 mmol/L) preoperative fasting blood glucose (FBG) ranges on the day of surgery.
  
  
  METHODS
  Prospective, randomized, open trial.
  
  
  METHODS
  Preoperative units at two sites of a suburban hospital system.
  
  
  METHODS
  401 adult, ASA physical status 3 and 4 patients with type 1 and type 2 diabetes, undergoing elective noncardiac surgery.
  
  
  METHODS
  Patients were divided into two groups according to absence of daily rapid-acting/short-acting insulin (insulin glargine-only group) or presence of daily rapid-acting/short-acting insulin (insulin glargine plus bolus group). Subjects were then randomized to three evening insulin glargine dosing strategies: (a) take 80% of usual dose, (b) call physician for dose, or (c) refer to dosing table, based on self-reported usual FBG and insulin regimen. In the prehospital setting, patients administered the instructed insulin glargine dose on the evening before surgery.
  
  
  METHODS
  Venous blood glucose values were recorded in the preoperative holding area on the day of surgery.
  
  
  RESULTS
  No significant differences in target preoperative FBG achievement were detected among strategies in the insulin glargine-only group (n = 174) or the insulin glargine plus bolus group (n = 227). In widened preoperative FBG achievement, no significant difference was noted among strategies in the insulin glargine-only group. In the insulin glargine plus bolus group, fewer subjects following the dosing table had FBG > 249 mg/dL (> 13.7 mmol/L; P = 0.031).
  
  
  CONCLUSIONS
  Target preoperative FBG achievement was similar among strategies in both insulin glargine groups. An insulin glargine adjustment strategy based on usual glycemic control may better prevent severe preoperative hyperglycemia in patients receiving basal/bolus regimens.
authors.affiliation: Oakland University William Beaumont Hospital School of Medicine, Rochester, MI 48309, USA.
authors.forename: Solomon I
authors.initials: SI
authors.lastname: Rosenblatt
authors.forename: Tamra
authors.initials: T
authors.lastname: Dukatz
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jahn
authors.forename: Craig
authors.initials: C
authors.lastname: Ramsdell
authors.forename: Alla
authors.initials: A
authors.lastname: Sakharova
authors.forename: Michelle
authors.initials: M
authors.lastname: Henry
authors.forename: Marina
authors.initials: M
authors.lastname: Arndt-Mutz
authors.forename: Virginia
authors.initials: V
authors.lastname: Miller
authors.forename: Kathleen
authors.initials: K
authors.lastname: Rogers
authors.forename: Mamtha
authors.initials: M
authors.lastname: Balasubramaniam
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine