Similar glycemic control found with basal bolus and basal plus regimens

For hospitalized patients with type 2 diabetes, a regimen of daily glargine supplemented with corrective doses of glulisine controlled blood glucose as well as a standard basal bolus regimen, a new study found.

The multicenter trial included 375 medical or surgical patients with type 2 diabetes usually treated with diet, oral antidiabetic agents or insulin at a dose of 0.4 unit/kg/day or less. During hospitalization, they were randomized to a basal bolus regimen (glargine once daily and glulisine before meals), a basal plus regimen (glargine once daily and corrective doses of glulisine given by sliding scale), or sliding-scale regular insulin.

Noting that clinicians have been reluctant to follow recommendations to switch from sliding scale to basal bolus, probably because of complexity and hypoglycemia risks, the authors hypothesized that a single daily dose of basal insulin might provide similar glucose control and lower hypoglycemia rates than a basal bolus regimen. The results were published by Diabetes Care on Feb. 22.

The study found that the basal bolus and basal plus regimens improved mean daily blood glucose after the first day of therapy by about the same amount. Both basal groups also had significantly lower mean daily blood glucose than the sliding-scale group. There were also significantly fewer patients with more than two consecutive glucose measurements above 240 mg/dL: 0% of the basal bolus group, 2% of the basal plus group and 19% of the sliding-scale group. Hypoglycemia (blood glucose under 70 mg/dL) occurred in 16% of basal bolus patients, 13% of basal plus patients and 3% of sliding-scale patients. The groups had similar rates of severe hypoglycemia (under 40 mg/dL).

Basal plus and basal bolus resulted in similar glycemic control, superior to that found with sliding scale, the study authors concluded. Based on these results, basal plus is an effective alternative to basal bolus for patients similar to those in this trial. The study was limited by its exclusion of ICU patients and those who had hepatic disease, creatinine ≥3.0 mg/dL, severe hyperglycemia or a usual insulin dose of more than 0.4 unit/kg/day. Higher insulin doses or a standard basal bolus regimen might be best for those patients, the authors noted.