title: Effect of two intensive insulin therapy regimens on perioperative glycemic control in bone fracture patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Currently, there are no uniform standards and methods for perioperative glycemic control in bone fracture patients with Type 2 diabetes mellitus (T2DM). We retrospectively analyzed the efficacy and safety of two intensive insulin therapy regimens administered to bone fracture patients with T2DM in the perioperative period, to explore the best method of achieving perioperative glycemic control.
  
  
  METHODS
  A number of 159 bone fracture patients with T2DM were divided into two groups. One group (n = 81) received multiple subcutaneous insulin injections (MSII group) and the other (n = 78) received continuous subcutaneous insulin infusion (CSII group). Blood glucose (BG) levels, time to achieve glycemic target, insulin dosage, and the incidence of hypoglycemia and complications were compared between groups.
  
  
  RESULTS
  Both regimens reduced BG to desired levels before surgery. The time to reach glycemic target in CSII group (2.5 days) was significantly shorter than that in the MSII group (7.3 days; P < 0.001). Mean insulin dosage in the CSII group (0.66 IU×kg(-1)×d(-1)) was significantly lower than that in the MSII group (0.74 IU×kg(-1)×d(-1); P = 0.005), as were the incidences of hypoglycemia (15.4% vs 32.1%) and infection (6.4% vs. 23.5%). Multiple regression analysis showed that the time to reach glycemia target was associated with the insulin therapy regimen and dosage. The insulin dosage on reaching glycemia target was positively associated with body mass index (BMI), diabetes mellitus course, glycated hemoglobin A1c (HbA1c), and β-hydroxybutyric acid, and was negatively associated with age.
  
  
  CONCLUSIONS
  The efficacy and safety of CSII was superior to that achieved with MSII, suggesting that CSII should be considered as initial therapy to control perioperative BG in bone fracture patients with T2DM.
authors.affiliation: Department of Endocrinology, Beijing Jishuitan Hospital, the Fourth Medical College of Peking University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Deng
authors.forename: Li-li
authors.initials: LL
authors.lastname: Huo
authors.forename: Ling
authors.initials: L
authors.lastname: Lan
authors.forename: Yan-wei
authors.initials: YW
authors.lastname: Lü
authors.forename: Man-yi
authors.initials: MY
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D050723:Fractures, Bone / Q000097:blood*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human