title: Effective adverse event reduction with bolus-basal versus sliding scale insulin therapy in patients with diabetes during conventional hospitalization: Systematic review and meta-analysis.
abstract: BACKGROUND
  The aim of this review was to assess the effectiveness to reduce clinical adverse events and safety of insulin administered in basal-bolus-corrector or basal-corrector regimens (BB) versus a sliding scale scheme (SS) in patients with diabetes or newly diagnosed hyperglycemia admitted to a conventional (not critical) medical or surgical hospital ward.
  
  
  METHODS
  A Medline search was conducted. The Odds ratio was the main summary measure. A random effects model with the Mantel-Haenszel procedure was used.
  
  
  RESULTS
  A total of 957 citations were collected, of which nine were finally included in the systematic review. Patients in the BB group had better blood glucose control than those with SS. Overall, there was a nonsignificant trend to a lower risk of adverse events in the BB as compared to the SS group (OR 0.67 [95% CI 0.22 to 2.04], [I(2)=71%]). There was a nonsignificant trend to an increased risk of hypoglycemia in the BB group (OR 2.29 [95% CI 0.50 to 10.49] [I(2)=70%]).
  
  
  CONCLUSIONS
  Despite its benefit for glycemic control during hospitalization, this review did not show that use of the BB scheme decreases clinical events in patients hospitalized in a conventional ward. Because of heterogeneity of the results, we think that clinical trials are needed addressing its effect in patient subgroups in which the BB scheme may be used safely and with longer follow-up periods.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: cova.gomez.cuervo@gmail.com.
authors.forename: Covadonga
authors.initials: C
authors.lastname: Gómez Cuervo
authors.affiliation: Servicio de Urgencias, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Sánchez Morla
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: María Asunción
authors.initials: MA
authors.lastname: Pérez-Jacoiste Asín
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Otilia
authors.initials: O
authors.lastname: Bisbal Pardo
authors.affiliation: Servicio de Urgencias, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Luis
authors.initials: L
authors.lastname: Pérez Ordoño
authors.affiliation: Servicio de Urgencias, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Juan
authors.initials: J
authors.lastname: Vila Santos
mesh_terms: D003920:Diabetes Mellitus / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Diabetes; Hospital medicine; Medicina hospitalaria; Meta-analysis; Metaanálisis