Randomized controlled trial of insulin supplementation for correction of bedtime hyperglycemia in hospitalized patients with type 2 diabetes
Open accessAbstract
OBJECTIVE: Clinical guidelines recommend point-of-care glucose testing and the use of supplemental doses of rapid-acting insulin before meals and at bedtime for correction of hyperglycemia. The efficacy and safety of this recommendation, however, have not been tested in the hospital setting. RESEARCH DESIGN AND METHODS: In this open-label, randomized controlled trial, 206 general medicine and surgery patients with type 2 diabetes treated with a basal-bolus regimen were randomized to receive either supplemental insulin (n = 106) at bedtime for blood glucose (BG) >7.8 mmol/L or no supplemental insulin (n = 100) except for BG >19.4 mmol/L. Point-of-care testing was performed before meals, at bedtime, and at 3:00 a.m. The primary outcome was the difference in fasting BG. In addition to the intention-to-treat analysis, an as-treated analysis was performed where the primary outcome was analyzed for only the bedtime BG levels between 7.8 and 19.4 mmol/L. RESULTS: There were no differences in mean fasting BG for the intention-to-treat (8.8 ± 2.4 vs. 8.6 ± 2.2 mmol/L, P = 0.76) and as-treated (8.9 ± 2.4 vs. 8.8 ± 2.4 mmol/L, P = 0.92) analyses. Only 66% of patients in the supplement and 8% in the no supplement groups received bedtime supplemental insulin. Hypoglycemia (BG <3.9 mmol/L) did not differ between groups for either the intention-to-treat (30% vs. 26%, P = 0.50) or the as-treated (4% vs. 8%, P = 0.37) analysis. CONCLUSIONS: The use of insulin supplements for correction of bedtime hyperglycemia was not associated with an improvement in glycemic control. We conclude that routine use of bedtime insulin supplementation is not indicated for management of inpatients with type 2 diabetes.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The basal-bolus regimen is labor intensive, needs multiple daily injections, and carries hypoglycemia risk affecting 10% to 30% of noncritically ill patients.
“Though effective, the basal-bolus regimen is labor intensive, requires several injections per day, and is associated with risk of hypoglycemia, affecting up to 10% to 30% of noncritically ill persons.102,1333”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1333]
The Introduction (page unavailable) describes multiple daily basal and mealtime insulin injections, and the Conclusions report a 20%–30% rate of mild hypoglycemia with basal-bolus treatment. The cited 10% lower bound is not reported. The Introduction calls point-of-care testing labor intensive, rather than explicitly applying that description to the basal-bolus regimen. (LLM, conf=0.82)
Experimental — accuracy not yet measuredRCTs showed that a basal prandial regimen with insulin analogs improved glycemic control and reduced hospital complications in general medical and surgical T2D patients compared with sliding-scale regular insulin alone.
“RCTs have shown that treatment with a basal prandial regimen using insulin analogs improved glycemic control with fewer hospital complications in general medical and surgical persons with T2D compared with sliding-scale regular insulin alone.92,107,108,1333–1336”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1333]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Standards of Medical Care in Diabetes
Power, D. V. (2006) · Diabetes Care · doi:10.2337/diacare.29.02.06.dc05-1593 · Cited by 8,672 · see citing works
Standards of medical care in diabetes—2014
American Diabetes Association (2014) · Diabetes Care · doi:10.2337/dc14-s014 · Cited by 4,572 · see citing works
Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes
Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.3.8341 · Cited by 2,195 · see citing works
Self-citationHyperglycemic crises in adult patients with diabetes
Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009) · Diabetes Care · doi:10.2337/dc09-9032 · Cited by 2,062 · see citing works
Self-citationManagement of diabetes and hyperglycemia in hospitals.
Clement, S., Braithwaite, S. S., Magee, M. F., Ahmann, A., Smith, E. P., Schafer, R. G., Hirsch, I. B., & on behalf of the Diabetes in Hospitals Writing Committee (2004) · Diabetes Care · doi:10.2337/diacare.27.2.553 · Cited by 1,266 · see citing works
Krinsley, J. S. (2003) · Mayo Clinic Proceedings · doi:10.4065/78.12.1471 · Cited by 1,165 · see citing works
Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., Seley, J. J., & Van den Berghe, G. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-2098 · Cited by 1,126 · see citing works
Self-citationUmpierrez, G. E., Smiley, D., Jacobs, S., Peng, L., Temponi, A., Mulligan, P., Umpierrez, D., Newton, C., Olson, D., & Rizzo, M. (2011) · Diabetes Care · doi:10.2337/dc10-1407 · Cited by 720 · see citing works
Self-citationUmpierrez, G. E., Smiley, D., Zisman, A., Prieto, L. M., Palacio, A., Ceron, M., Puig, A., & Mejia, R. (2007) · Diabetes Care · doi:10.2337/dc07-0295 · Cited by 671 · see citing works
Self-citationMoghissi, E. S., Korytkowski, M. T., DiNardo, M. M., EINHORN, D. F., Hellman, R., Hirsch, I. B., Inzucchi, S. E., Ismail‐Beigi, F., Kirkman, M. S., & Umpierrez, G. E. (2009) · Endocrine Practice · doi:10.4158/ep09102.ra · Cited by 516 · see citing works
Self-citationManagement of Hyperglycemia in the Hospital Setting
Inzucchi, S. E. (2006) · New England Journal of Medicine · doi:10.1056/nejmcp060094 · Cited by 391 · see citing works
Hypoglycemia as a Predictor of Mortality in Hospitalized Elderly Patients
Kagansky, N., Levy, S., Rimon, E., Cojocaru, L., Fridman, A., Ozer, Z., & Knobler, H. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.15.1825 · Cited by 231 · see citing works
Umpierrez, G. E., Smiley, D., Hermayer, K., Khan, A., Olson, D. E., Newton, C., Jacobs, S., Rizzo, M., Peng, L., Reyes, D., et al. (2013) · Diabetes Care · doi:10.2337/dc12-1988 · Cited by 222 · see citing works
Self-citationUmpierrez, G. E., Hor, T., Smiley, D. D., Temponi, Á., Umpierrez, D., Cerón, M., Munoz, C., Newton, C. A., Peng, L., & Baldwin, D. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1441 · Cited by 180 · see citing works
Self-citationHypoglycemia-associated mortality is not drug-associated but linked to comorbidities
Boucai, L., Southern, W. N., & Zonszein, J. (2011) · The American Journal of Medicine · doi:10.1016/j.amjmed.2011.07.011 · Cited by 175 · see citing works
Elevated Admission Glucose and Mortality in Elderly Patients Hospitalized With Heart Failure
Kosiborod, M., Inzucchi, S. E., Spertus, J. A., Wang, Y., Masoudi, F. A., Havranek, E. P., & Krumholz, H. M. (2009) · Circulation · doi:10.1161/circulationaha.108.821843 · Cited by 131 · see citing works
Insulin Therapy for the Management of Hyperglycemia in Hospitalized Patients
McDonnell, M. E., & Umpierrez, G. E. (2012) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2012.01.001 · Cited by 118 · see citing works
Self-citationLee-Lewandrowski, E., Laposata, M., Eschenbach, K., CAMOOSO, C., Nathan, D. M., Godine, J. E., Hurxthal, K., Goff, J., & Lewandrowski, K. B. (1994) · The American Journal of Medicine · doi:10.1016/0002-9343(94)90004-3 · Cited by 63 · see citing works
Rajendran, R., Kerry, C., Rayman, G. A., & on behalf of the MaGIC study group (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005165 · Cited by 38 · see citing works
Self-monitoring of blood glucose
Garg, S. K., & Hirsch, I. B. (2010) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2009.02271.x · Cited by 34 · see citing works
Cost Analysis: Bedside Blood Glucose Testing
Greendyke, R. M. (1992) · American Journal of Clinical Pathology · doi:10.1093/ajcp/97.1.106 · Cited by 32 · see citing works
Kerry, C., Mitchell, S., Sharma, S., Scott, A., & Rayman, G. A. (2013) · Diabetic Medicine · doi:10.1111/dme.12256 · Cited by 18 · see citing works
Trends in recorded capillary blood glucose and hypoglycaemia in hospitalised patients with diabetes
Jones, G. C., Casey, H. M., Perry, C. G., Kennon, B., & Sainsbury, C. A. R. (2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2014.01.021 · Cited by 17 · see citing works
The Nuts and Bolts of Subcutaneous Insulin Therapy in Non-Critical Care Hospital Settings
Juneja, R., Foster, S. A., Whiteman, D., & Fahrbach, J. L. (2010) · Postgraduate Medicine · doi:10.3810/pgm.2010.01.2109 · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507 · see citing works
Self-citationManagement of diabetes and hyperglycaemia in the hospital
Pasquel, F. J., Lansang, M. C., Dhatariya, K., & Umpierrez, G. E. (2021) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30381-8 · Cited by 329 · see citing works
Self-citationPasquel, F. J., Gianchandani, R., Rubin, D. J., Dungan, K. M., Anzola, I., Gomez, P. C., Peng, L., Hodish, I., Bodnar, T., Wesorick, D., et al. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(16)30402-8 · Cited by 168 · see citing works
Self-citationSingh, L. G., Satyarengga, M., Marcano, I., Scott, W. H., Pinault, L. F., Feng, Z., Sorkin, J. D., Umpierrez, G. E., & Spanakis, E. K. (2020) · Diabetes Care · doi:10.2337/dc20-0840 · Cited by 154 · see citing works
Self-citationVellanki, P., Rasouli, N., Baldwin, D., Alexanian, S., Anzola, I., Urrutia, M., Cardona, S., Peng, L., Pasquel, F. J., Umpierrez, G. E., et al. (2019) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.13587 · Cited by 80 · see citing works
Self-citationPasquel, F. J., Gomez-Huelgas, R., Anzola, I., Oyedokun, F., Haw, J. S., Vellanki, P., Peng, L., & Umpierrez, G. E. (2015) · Diabetes Care · doi:10.2337/dc15-1835 · Cited by 55 · see citing works
Self-citationSliding scale insulin for non-critically ill hospitalised adults with diabetes mellitus
Colunga‐Lozano, L. E., Torres, F. J. G., Delgado-Figueroa, N., González‐Padilla, D. A., Hernández, A. V., Roman, Y. M., & Cuello‐García, C. A. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011296.pub2 · Cited by 47 · see citing works
Inpatient Diabetes Management in the Twenty-First Century
Khazai, N. B., & Hamdy, O. (2016) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2016.06.013 · Cited by 26 · see citing works
Toyoshima, M. T. K., de Souza, A. B. C., Admoni, S. N., Cukier, P., Lottenberg, S. A., Latronico, A. C., & Nery, M. (2015) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-015-0111-7 · Cited by 16 · see citing works
Gosmanov, A. R. (2016) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2016.05.002 · Cited by 16 · see citing works
Guardado‐Mendoza, R., Cázares-Sánchez, D., Evia-Viscarra, M. L., Jiménez-Ceja, L. M., Pérez, E. G. D., & Aguilar-García, A. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.107864 · Cited by 12 · see citing works
Challenges and Strategies for Inpatient Diabetes Management in Older Adults
Gosmanov, A. R., Mendez, C. E., & Umpierrez, G. E. (2020) · Diabetes Spectrum · doi:10.2337/ds20-0008 · Cited by 12 · see citing works
Self-citationVellanki, P., Cardona, S., Galindo, R. J., Urrutia, M. A., Pasquel, F. J., Davis, G. M., Fayfman, M., Migdal, A., Peng, L., & Umpierrez, G. E. (2022) · Diabetes Care · doi:10.2337/dc21-1606 · Cited by 10 · see citing works
Self-citationPremixed Insulin Analogue Compared with Basal-Plus Regimen for Inpatient Glycemic Control
Gracia‐Ramos, A. E., Cruz-Domínguez, M. P., Madrigal‐Santillán, E., Morales‐González, J. A., Madrigal‐Bujaidar, E., & Aguilar-Faisal, L. (2016) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0176 · Cited by 10 · see citing works
Ena, J., Gómez‐Huelgas, R., Zapatero, A., Vázquez-Rodríguez, P., González-Becerra, C., Romero-Sánchez, M., Igúzquiza-Pellejero, M. J., Artero, A., & Varela-Aguilar, J. M. (2016) · Revista Clínica Española · doi:10.1016/j.rce.2016.05.006 · Cited by 8 · see citing works
Marino, E. C., Momesso, D., Toyoshima, M. T. K., de Almeida, M. F. O., Schaan, B. D., Negretto, L. A. F., Junior, A. C. S., Cukier, P., Genestreti, P., Feitosa, A. C. R., et al. (2025) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-025-01585-z · Cited by 6 · see citing works
Manejo de pacientes diabéticos hospitalizados
Román-Gonzaléz, A., Cardona, A., Gutiérrez-Restrepo, J., & Palacio, A. (2018) · Revista de la Facultad de Medicina · doi:10.15446/revfacmed.v66n3.61890 · Cited by 5 · see citing works
Zhang, X., Zhang, T., Xiang, G., Wang, W., Li, Y., Du, T., Zhao, Y., Mosha, S. S., & Li, W. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001261 · Cited by 5 · see citing works
Ena, J., Gómez‐Huelgas, R., Zapatero, A., Vázquez-Rodríguez, P., González-Becerra, C., Romero-Sánchez, M., Igúzquiza-Pellejero, M. J., Artero, A., & Varela-Aguilar, J. M. (2016) · Revista Clínica Española (English Edition) · doi:10.1016/j.rceng.2016.05.004 · Cited by 4 · see citing works
Gracia‐Ramos, A. E., Cruz-Domínguez, M. P., & Madrigal‐Santillán, E. (2021) · Revista Clínica Española (English Edition) · doi:10.1016/j.rceng.2021.09.003 · Cited by 3 · see citing works
Kanbour, S., Zale, A. D., Shim, J., Abusamaan, M. S., & Mathioudakis, N. N. (2025) · Endocrine Practice · doi:10.1016/j.eprac.2025.01.008 · Cited by 2 · see citing works
Myers, A. K., Garnica, P., & Ling, J. (2018) · American Journal of Therapeutics · doi:10.1097/mjt.0000000000000667 · Cited by 2 · see citing works
Ahmed, R., de Souza, R. J., Li, V., & Anand, S. S. (2022) · medRxiv · doi:10.1101/2022.06.28.22275821 · Cited by 3 · see citing works
Flory, J., Vertosick, E., Kuperman, G. J., Ancker, J. S., Kim, S. Y. H., Fitzpatrick, C., Gould, K., Weiss, E., & Vickers, A. J. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112428 · Cited by 1 · see citing works
The Art and Science of Antidiabetic Medications and Obesity Management
Sawhney, S. K., Kapri, A., Chaudhary, G., & Chauhan, B. (2025) · Mini-Reviews in Medicinal Chemistry · doi:10.2174/0113895575413887251001111806 · Cited by 1 · see citing works
Camuto, P., Guadagnini, D., Assalin, H. B., Magro, D. O., Santos, A., & Saad, M. J. A. (2026) · AACE Endocrinology and Diabetes · doi:10.1016/j.aed.2026.06.010 · Cited by 1 · see citing works
Insulin Other Hypoglycemic Drugs
Trovinger, S. N., Hrometz, S. L., Keshishyan, S., & Ray, S. D. (2016) · Side effects of drugs annual · doi:10.1016/bs.seda.2016.07.003 · Cited by 1 · see citing works
Impact of Insulin Detemir Administration Time on Hypoglycemia Rates in Hospitalized Patients
Grelle, J. L., Kutter, S. N., Giruzzi, M. E., & Tawwater, J. C. (2017) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.2045 · Cited by 1 · see citing works
Principles of Care in the Diabetic Surgical Patient
Khazai, N. B., & Hamdy, O. (2018) · Contemporary diabetes · doi:10.1007/978-3-319-89869-8_6
Gracia‐Ramos, A. E., Cruz-Domínguez, M. P., & Madrigal‐Santillán, E. (2021) · Revista Clínica Española · doi:10.1016/j.rce.2021.09.002
Zhang, X., Yan, D., Du, T., Zhao, Y., Zhang, J., Zhang, T., Lin, M., Li, Y., & Li, W. (2023) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-023-01193-9
Impact of Lowered Inpatient Correctional Bedtime Insulin Dosing on Glycemic Outcomes of Veterans
Hiscox, A., Armbrust, J., Shin, M., & Bahng, J. (2024) · Journal of Pharmacy Practice · doi:10.1177/08971900241228776
Less Is More: Backing off Sliding Scale Insulin for Hospitalized Patients
Karra, L., Radi, R., & Lyon, C. (2024) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2023.230349r1
Principles of Care in the Diabetic Surgical Patient
Khazai, N. B., & Hamdy, O. (2024) · Contemporary diabetes · doi:10.1007/978-3-031-55715-6_6
Passarella, P., & Gosmanov, A. (2025) · The Medical clinics of North America · doi:10.1016/j.mcna.2025.11.001
Patil, K. S., Patil, J. K., & Patil, J. K. (2026) · Asian Journal of Pharmaceutical Research · doi:10.52711/2231-5675.2026.00050
- Authors
- Vellanki, P., Bean, R., Oyedokun, F. A., Pasquel, F. J., Smiley, D., Farrokhi, F., Newton, C., Peng, L., & Umpierrez, G. E.
- Affiliations
- Emory University (US)
- Corresponding author
- Umpierrez, Guillermo E.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-02-09
- Volume
- 38
- Issue
- 4
- Pages
- 568-574
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4370326
- OpenAlex
- W2058690973
- Cited by
- 36
- References
- 24
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 1 · 2018: 5 · 2017: 1 · 2016: 7 · 2015: 2
- FWCI
- 4.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR000454)
- National Center for Research Resources (M01-RR00039, UL1RR025008, M01RR000039)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, insulin supplementation, multiple daily insulin injections, hospitalized patients, point-of-care glucose testing, hypoglycemia, fasting blood glucose, glycemic control, rapid-acting insulin
- MeSH terms
- Aged, Blood Glucose, Circadian Rhythm, Diabetes Mellitus, Type 2, Drug Administration Schedule, Female, Hospitalization, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Isophane, Male, Middle Aged, Sleep, Insulin, Long-Acting, Insulin, Short-Acting, Insulin Lispro, Meals
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
