Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes
Open accessAbstract
OBJECTIVE: Premixed insulin is a commonly prescribed formulation for the outpatient management of patients with type 2 diabetes. The safety and efficacy of premixed insulin formulations in the hospital setting is not known. RESEARCH DESIGN AND METHODS: In a prospective, open-label trial, we randomized general medicine and surgery patients to receive a basal-bolus regimen with glargine once daily and glulisine before meals (n = 33) or premixed human insulin (30% regular insulin and 70% NPH insulin) twice daily (n = 39). Major outcomes included differences in daily blood glucose (BG) levels and frequency of hypoglycemic events (<70 mg/dL) between treatment groups. RESULTS: At the first prespecified interim analysis, the study was stopped early because of an increased frequency of hypoglycemia >50% in patients treated with premixed human insulin. A total of 64% of patients treated with premixed insulin experienced one or more episodes of hypoglycemia compared with 24% in the basal-bolus group (P < 0.001). There were no differences in mean daily BG level after the first day of insulin treatment (175 ± 32 vs. 179 ± 43 mg/dL, P = 0.64) between groups. A BG target between 80 and 180 mg/dL before meals was achieved in 55.9% of BG readings in the basal-bolus group and 54.3% of BG readings in the premixed insulin group (P = 0.23). There was no difference in the length of hospital stay or mortality between treatment groups. CONCLUSIONS: Inpatient treatment with premixed human insulin resulted in similar glycemic control but in significantly higher frequency of hypoglycemia compared with treatment with basal-bolus insulin regimen in hospitalized patients with diabetes.
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A prospective randomized inpatient study of 70/30 intermediate-acting (NPH)/regular insulin mixture versus basal-bolus therapy showed comparable glycemic outcomes but significantly increased hypoglycemia in the group receiving the insulin mixture.
“A prospective randomized inpatient study of 70/30 intermediate-acting (NPH)/ regular insulin mixture versus basal-bolus therapy showed comparable glycemic outcomes but significantly increased hypoglycemia in the group receiving the insulin mixture (77).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [77]
In a single-center RCT, correctional insulin sliding scales for bedtime hyperglycemia did not improve glycemic control in T2D patients.
“In a single-center RCT, the use of correctional insulin sliding scales for bedtime hyperglycemia did not improve glycemic control in persons with T2D.1341,1342”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1341]
The Insulin Treatment section describes randomization to basal-bolus or premixed insulin, not bedtime correctional sliding scales. The Conclusions report improved glycemic control with both regimens. Searches for bedtime correctional insulin and its effect on glycemic control found no passage addressing the claimed comparison; page numbers were unavailable in our copy. (LLM, conf=0.78)
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- Authors
- Bellido, V., Suarez, L., Rodriguez, M. G., Sanchez, C., Dieguez, M., Riestra, M., Casal, F., Delgado, E., Menendez, E., & Umpierrez, G. E.
- Affiliations
- Hospital Universitario Central de Asturias (ES)
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
- Hospital de Cabueñes, Gijón, Asturias, Spain
- Hospital Universitario De Cabueñes (ES)
- Emory University (US)
- Corresponding author
- Bellido, Virginia
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-10-12
- Volume
- 38
- Issue
- 12
- Pages
- 2211-2216
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4657612
- OpenAlex
- W2177119636
- Cited by
- 118
- References
- 32
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 11 · 2023: 8 · 2022: 13 · 2021: 18 · 2020: 14 · 2019: 7 · 2018: 16 · 2017: 12 · 2016: 4 · 2015: 1
- FWCI
- 9.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi Aventis
- 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, premixed insulin, multiple daily insulin injections, hospitalized patients, hypoglycemia, glycemic control, glargine, glulisine, NPH insulin, blood glucose
- MeSH terms
- Insulin Glargine, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Drug Combinations, Female, Hospitalization, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin, Isophane, Male, Middle Aged, Prospective Studies, Insulin, Regular, Human
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