title: Randomized study comparing a Basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: basal plus trial.
abstract: OBJECTIVE
  Effective and easily implemented insulin regimens are needed to facilitate hospital glycemic control in general medical and surgical patients with type 2 diabetes (T2D).
  
  
  METHODS
  This multicenter trial randomized 375 patients with T2D treated with diet, oral antidiabetic agents, or low-dose insulin (≤ 0.4 units/kg/day) to receive a basal-bolus regimen with glargine once daily and glulisine before meals, a basal plus regimen with glargine once daily and supplemental doses of glulisine, and sliding scale regular insulin (SSI).
  
  
  RESULTS
  Improvement in mean daily blood glucose (BG) after the first day of therapy was similar between basal-bolus and basal plus groups (P = 0.16), and both regimens resulted in a lower mean daily BG than did SSI (P = 0.04). In addition, treatment with basal-bolus and basal plus regimens resulted in less treatment failure (defined as >2 consecutive BG >240 mg/dL or a mean daily BG >240 mg/dL) than did treatment with SSI (0 vs. 2 vs. 19%, respectively; P < 0.001). A BG <70 mg/dL occurred in 16% of patients in the basal-bolus group, 13% in the basal plus group, and 3% in the SSI group (P = 0.02). There was no difference among the groups in the frequency of severe hypoglycemia (<40 mg/dL; P = 0.76).
  
  
  CONCLUSIONS
  The use of a basal plus regimen with glargine once daily plus corrective doses with glulisine insulin before meals resulted in glycemic control similar to a standard basal-bolus regimen. The basal plus approach is an effective alternative to the use of a basal-bolus regimen in general medical and surgical patients with T2D.
authors: Department of Medicine, Division of Endocrinology, Emory University, Atlanta, Georgia, USA. geumpie@emory.edu
authors: Guillermo E
authors: GE
authors: Umpierrez
authors: Dawn
authors: D
authors: Smiley
authors: Kathie
authors: K
authors: Hermayer
authors: Amna
authors: A
authors: Khan
authors: Darin E
authors: DE
authors: Olson
authors: Christopher
authors: C
authors: Newton
authors: Sol
authors: S
authors: Jacobs
authors: Monica
authors: M
authors: Rizzo
authors: Limin
authors: L
authors: Peng
authors: David
authors: D
authors: Reyes
authors: Ingrid
authors: I
authors: Pinzon
authors: Maria Eugenia
authors: ME
authors: Fereira
authors: Vicky
authors: V
authors: Hunt
authors: Ashwini
authors: A
authors: Gore
authors: Marcos T
authors: MT
authors: Toyoshima
authors: Vivian A
authors: VA
authors: Fonseca
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage; D008297:Male; D062407:Meals; D008875:Middle Aged; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; C479079:insulin glulisine