Sliding Scale Insulin vs Basal-Bolus Insulin Therapy in Long-Term Care: A 21-Day Randomized Controlled Trial Comparing Efficacy, Safety and Feasibility

Abstract

B-BI therapy produced significantly lower average FBG levels after 21 days compared with SSI therapy; both groups had similar rates of hypo- and hyperglycemia. Switching to B-BI therapy is feasible, safe, and effective in the LTC setting.

Identifying the need for simplification of type 2 diabetes mellitus treatment in residents of aged-care facilities: a meta-analysis and systematic review of the literature

“…11 Similarly, Dharmarajan et al demonstrated significantly lower fasting BG in those on BB insulin regimens compared with SS. 15 Here, there were no significant differences in the incidence of hypoglycaemia, although data collection for this occurred over a three-day period only. 15 Two of the studies used HbA1c to report the impact of simplification on glycaemic control.…”

“…Niznik et al, 2020 10 Umpierrez et al, 2018 11 McCracken et al, 2017 12 Retornaz et al, 2017 13 Walfridsson et al, 2016 14 Dharmarajan et al, 2016 15 Bo et al, 2015 16 To explore predictors for diabetes treatment deintensification…”

“…Multiple observational and cross-sectional studies have investigated the prevalence of hypoglycaemia and used HbA1c as a marker of glycaemic control. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] We identified 16 studies (collectively involving 7,869 aged-care residents with T2DM) in which data on HbA1c were collected and compared to evaluate glycaemic control. Among these studies, the mean HbA1c was 51.9 mmol/mol (95% CI 52.0 to 51.8 mmol/mol); Figure 2).…”

“…However, of the five studies reporting grouped values, HbA1c <53 mmol/mol was seen in 43-55%. [14][15][16]19,22 With the IDF recommending a target HbA1c of 53-64 mmol/mol in functionally dependent older adults, with lenience to <70 mmol/mol in those frail or living with dementia, 9 this suggests significant overtreatment of this population cohort. Interestingly, higher HbA1c levels were also associated with an increased risk of developing hypoglycaemia, 10,13,14 reflecting poor glycaemic control at both ends of the HbA1c spectrum.…”

“…21 Dharmarajan et al explored simplifying insulin regimens from sliding scale (SS) to basal bolus (BB). 15 A study by Umpierrez et al was the only one to compare basal insulin (glargine) with DPP4 inhibitor (linagliptin) monotherapy. 11 Of the two studies reporting BG levels, both showed reduced glycaemic variability with simplified treatment.…”