Comparison of efficacy and safety of glargine and detemir insulin in the management of inpatient hyperglycemia and diabetes
Open accessAbstract
Objective Glargine and detemir insulin are the two most commonly prescribed basal insulin analogues for the ambulatory and inpatient management of diabetes. The efficacy and safety of basal insulin analogues in the hospital setting has not been established.Methods This observational study compared differences in glycemic control and outcomes in non-intensive care unit patients with blood glucose (BG) >140 mg/dL who were treated with glargine or detemir, between January 1, 2012, and September 30, 2015, in two academic centers.Results Among 6,245 medical and surgical patients with hyperglycemia, 5,749 received one or more doses of glargine, and 496 patients received detemir during the hospital stay. There were no differences in the mean daily BG (glargine, 182 ± 46 mg/dL vs. detemir, 180 ± 44 mg/dL; P = .70). There were no differences in mortality, hospital complications, or re-admissions between groups (all, P>.05). After adjusting for potential confounders, there was no statistically significant difference in hypoglycemia rates between treatment groups. Patients treated with detemir required higher total daily basal insulin doses (0.27 ± 0.16 units/kg/day vs. 0.22 ± 0.15 units/kg/day; P<.001). Glargine-treated patients had statistically longer length of stay; however, this difference may not be clinically relevant (6.8 ± 7.4 days vs. 6.0 ± 6.3 days; P<.001).Conclusion Our study indicates that treatment with glargine and detemir results in similar inpatient glycemic control in general medicine and surgery patients. Detemir treatment was associated with higher daily basal insulin dose and number of injections. A prospective randomized study is needed to confirm these findings.Abbreviations BG = blood glucose BMI = body mass index CI = confidence interval eGFR = estimated glomerular filtration rate HbA1c = glycated hemoglobin ICD-9 = International Classification of Diseases, ninth revision ICU = intensive care unit IQR = interquartile range LOS = length-of-stay OR = odd ratio.
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RCTs 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 [1336]
The Introduction and Discussion report that randomized trials found better glycemic control and fewer hospital complications with basal-bolus insulin analog regimens than with sliding-scale insulin in hospitalized patients with type 2 diabetes. They do not specify that the sliding-scale comparator was regular insulin alone. (LLM, conf=0.82)
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- Authors
- Galindo, R. J., Davis, G. M., Fayfman, M., Reyes-Umpierrez, D., Alfa, D., Peng, L., Tamler, R., Pasquel, F. J., & Umpierrez, G. E.
- Affiliations
- Emory University (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Umpierrez, Guillermo E.
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 23
- Issue
- 9
- Pages
- 1059-1066
- ISSN
- 1530-891X (ISSN-L)
- PMC
- PMC6052791
- OpenAlex
- W2728523557
- Cited by
- 21
- References
- 27
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 2 · 2018: 4
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)
- National Center for Research Resources (UL1RR025008)
- 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
- glargine, basal insulin analogues, inpatient hyperglycemia, glycemic control, hypoglycemia, length of hospital stay, basal insulin dose, diabetes management, medical-surgical patients
- MeSH terms
- Insulin Glargine, Insulin Detemir, Aged, Blood Glucose, Diabetes Mellitus, Female, Humans, Hyperglycemia, Hypoglycemic Agents, Inpatients, Length of Stay, Male, Middle Aged
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