TITLE

Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 Trial)

AUTHOR(S)
Umpierrez, Guillermo E.; Smiley, Dawn; Zisman, Ariel; Prieto, Luz M.; Palacio, Andres; Ceron, Miguel; Puig, Alvaro; Mejia, Roberto
PUB. DATE
September 2007
SOURCE
Diabetes Care;Sep2007, Vol. 30 Issue 9, p2181
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE--We sought to study the optimal management of hyperglycemia in nonintensive care unit patients with type 2 diabetes, as few studies thus far have focused on the subject. RESEARCH DESIGN AND METHODS--We conducted a prospective, multicenter, randomized trial to compare the efficacy and safety of a basal-bolus insulin regimen with that of sliding-scale regular insulin (SSI) in patients with type 2 diabetes. A total of 130 insulin-naive patients were randomized to receive glargine and glulisine (n = 65) or a standard SSI protocol (n = 65). Glargine was given once daily and glulisine before meals at a starting dose of 0.4 units ⋅ kg-1 ⋅ day-1 for blood glucose 140-200 mg/dl or 0.5 units ⋅ kg-1 ⋅ day-1 for blood glucose 201-400 mg/dl. SSI was given four times per day for blood glucose >140 mg/dl. RESULTS--The mean admission blood glucose was 229 ± 6 mg/dl and A1C 8.8 ± 2%. A blood glucose target of <140 mg/dl was achieved in 66% of patients in the glargine and glulisine group and in 38% of those in the SSI group. The mean daily blood glucose between groups ranged from 23 to 58 mg/dl, with an overall blood glucose difference of 27 mg/dl (P < 0.01). Despite increasing insulin doses, 14% of patients treated with SSI remained with blood glucose >240 mg/dl. There were no differences in the rate of hypoglycemia or length of hospital stay. CONCLUSIONS--Treatment with insulin glargine and glulisine resulted in significant improvement in glycemic control compared with that achieved with the use of SSI alone. Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the management of non-critically ill, hospitalized patients with type 2 diabetes.
ACCESSION #
26644191

 

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