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Cited by 42Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchDiabetes Treatment and Management

Basal–bolus insulin versus sliding‐scale insulin for inpatient glycaemic control: a clinical practice comparison

Roberts, Greg W, Aguilar‐Loza, Norma, Esterman, Adrian, Burt, Morton G, Stranks, Stephen N·2012·Medical Journal of Australia
DOI 10.5694/mja11.10853
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Abstract

OBJECTIVE: To determine if the improvement in inpatient glycaemic control observed with basal-bolus insulin (BBI) over sliding-scale insulin (SSI) in the formal study setting translates to routine clinical conditions. DESIGN, SETTING AND PATIENTS: Cross-sectional study in which capillary blood glucose levels (BGLs) were prospectively measured four times daily for up to 8 days in 124 patients with type 2 diabetes admitted to a tertiary teaching hospital and treated with BBI between November 2008 and May 2010. Data from the BBI treatment group were compared with retrospective data from 96 patients treated with SSI between June 2001 and May 2006. MAIN OUTCOME MEASURES: Mean daily BGL; independent effect of insulin regimen on mean daily BGL. RESULTS: Mean baseline BGL was not significantly different in patients receiving BBI and SSI (mean ± SD, 11.3 ± 4.1 v 10.6 ± 4.3 mmol/L; P = 0.23). After the first full day of therapy, mean daily BGL for patients receiving BBI was 1.6 ± 3.7 mmol/L lower than baseline BGL, and it remained 1.6-2.4 mmol/L lower than baseline throughout the study (P < 0.001). In contrast, there was no significant change in BGL for patients receiving SSI. Random effects regression analysis indicated that BBI was associated with a significantly lower mean daily BGL than SSI, independent of other variables (P < 0.001). The incidence of hypoglycaemia (BGL < 4 mmol/L) was significantly greater in patients receiving BBI than SSI (3.3% v 1.4%; P < 0.001), but there was no significant difference for severe hypoglycaemia (BGL < 2.8 mmol/L) (0.3 v 0.5%; P = 0.3). CONCLUSIONS: Under routine clinical conditions, BBI is effective and safe across a range of patients and appears to be superior to SSI. Clinical improvements reflected those seen in a strict formal study setting.

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Authors
Roberts, G. W., Aguilar‐Loza, N., Esterman, A., Burt, M. G., & Stranks, S. N.
Affiliations
  • Flinders University (AU)
  • Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, SA.
  • University of South Australia (AU)
ORCID
Venue
Medical Journal of Australia
Publisher
Wiley
Published
2012-03
Volume
196
Issue
4
Pages
266-269
ISSN
  • 0025-729X (ISSN-L)
  • 1326-5377
DOI
10.5694/mja11.10853
OpenAlex
W1978968721
Cited by
42
References
25
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 3 · 2019: 2 · 2018: 4 · 2017: 1 · 2016: 7 · 2015: 7 · 2014: 3 · 2013: 7
FWCI
4.36
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Medical Journal of Australia (publishedVersion)
  • PubMed (publishedVersion)
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
multiple daily insulin injections, sliding scale insulin, type 2 diabetes, hypoglycemia, capillary blood glucose, insulin regimens, hospitalization, routine clinical practice
MeSH terms
Adult, Aged, Australia, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Hyperglycemia, Hypoglycemia, Inpatients, Insulin, Male, Middle Aged, Practice Patterns, Physicians', Prognosis, Prospective Studies, Treatment Outcome, Risk Assessment, Pulse Therapy, Drug, Insulin, Long-Acting

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