Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery)
By G. Umpierrez, D. Smiley, S. Jacobs, Limin Peng, A. Temponi, Patrick Mulligan, Denise Umpierrez, Christopher Newton, D. Olson, M. Rizzo. Diabetes Care, 2011
705 citations recorded by the source corpus.
OBJECTIVE The optimal treatment of hyperglycemia in general surgical patients with type 2 diabetes mellitus is not known. RESEARCH DESIGN AND METHODS This randomized multicenter trial compared the safety and efficacy of a basal-bolus insulin regimen with glargine once daily and glulisine before meals (n = 104) to sliding scale regular insulin (SSI) four times daily (n = 107) in patients with type 2 diabetes mellitus undergoing general surgery. Outcomes included differences in daily blood glucose (BG) and a composite of postoperative complications including wound infection, pneumonia, bacteremia, and respiratory and acute renal failure. RESULTS The mean daily glucose concentration after the 1st day of basal-bolus insulin and SSI was 145 ± 32 mg/dL and 172 ± 47 mg/dL, respectively (P < 0.01). Glucose readings <140 mg/dL were recorded in 55% of patients in basal-bolus and 31% in the SSI group (P < 0.001). There were reductions with basal-bolus as compared with SSI in the composite outcome [24.3 and 8.6%; odds ratio 3.39 (95% CI 1.50–7.65); P = 0.003]. Glucose <70 mg/dL was reported in 23.1% of patients in the basal-bolus group and 4.7% in the SSI group (P < 0.001), but there were no significant differences in the frequency of BG <40 mg/dL between groups (P = 0.057). CONCLUSIONS Basal-bolus treatment with glargine once daily plus glulisine before meals improved glycemic control and reduced hospital complications compared with SSI in general surgery patients. Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the hospital management of general surgery patients with type 2 diabetes.
Subfields: Endocrinology, Diabetes and Metabolism, Surgery
View Paper: https://www.semanticscholar.org/paper/e8b4752868794ecd3ad8f15f675c5a96668e2591
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In Endocrinology, Diabetes and Metabolism
In Surgery
Citations in the corpus
- Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. (2012, methodology): “The safety of scheduled basal bolus insulin in patients with either newly recognized hyperglycemia or type 2 diabetes has been demonstrated in several studies of noncritically ill hospitalized patients (33, 35, 69, 74).”
- Standards of Medical Care in Diabetes—2014 (2013, background): “outcomes in general surgery patients with type 2 diabetes (568).”
- Standards of Medical Care in Diabetes—2013 (2012, background): “Prolonged therapy with sliding-scale insulin (SSI) as the sole regimen is ineffective in the majority of patients, increases risk of both hypoglycemia and hyperglycemia, and has recently been shown in a randomized trial to be associated with adverse outcomes in general surgery patients with type 2 d”