title: Differences in inpatient glycemic control and response to subcutaneous insulin therapy between medicine and surgery patients with type 2 diabetes.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Division of Endocrinology at Emory University, Atlanta, GA, USA. Electronic address: dsmiley@emory.edu.
authors.forename: Dawn
authors.initials: D
authors.lastname: Smiley
authors.forename: Guillermo E
authors.initials: GE
authors.lastname: Umpierrez
authors.forename: Kathie
authors.initials: K
authors.lastname: Hermayer
authors.forename: Christopher
authors.initials: C
authors.lastname: Newton
authors.forename: Sol
authors.initials: S
authors.lastname: Jacobs
authors.forename: Darin E
authors.initials: DE
authors.lastname: Olson
authors.forename: Amna
authors.initials: A
authors.lastname: Khan
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
authors.forename: Limin
authors.initials: L
authors.lastname: Peng
authors.forename: David
authors.initials: D
authors.lastname: Reyes
authors.forename: Saumeth
authors.initials: S
authors.lastname: Cardona
authors.forename: Vivian
authors.initials: V
authors.lastname: Fonseca
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D007297:Inpatients / Q000706:statistics & numerical data; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; C479079:insulin glulisine
keywords: Basal insulin; Glargine; Glulisine; Hospital hyperglycemia; Inpatient hyperglycemia; Medicine and surgery patients; Sliding scale insulin; Type 2 diabetes
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