Sliding-Scale versus Basal-Bolus Insulin in the Management of Severe or Acute Hyperglycemia in Type 2 Diabetes Patients: A Retrospective Study

Abstract

Sliding-scale and basal-bolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2 diabetes mellitus patients. Although its use is not recommended, sliding-scale insulin therapy is still being used widely. The aims of the study were to compare the glycemic control achieved by using sliding-scale or basal-bolus regimens for the management of severe or acute hyperglycemia in patients with type 2 diabetes and to analyze factors associated with the types of insulin therapy used in the management of severe or acute hyperglycemia. This retrospective study was conducted using the medical records of patients with acute or severe hyperglycemia admitted to a hospital in Malaysia from January 2008 to December 2012. A total of 202 patients and 247 admissions were included. Patients treated with the basal-bolus insulin regimen attained lower fasting blood glucose (10.8±2.3 versus 11.6±3.5 mmol/L; p = 0.028) and mean glucose levels throughout severe/acute hyperglycemia (12.3±1.9 versus 12.8±2.2; p = 0.021) compared with sliding-scale insulin regimens. Diabetic ketoacidosis (p = 0.043), cardiovascular diseases (p = 0.005), acute exacerbation of bronchial asthma (p = 0.010), and the use of corticosteroids (p = 0.037) and loop diuretics (p = 0.016) were significantly associated with the type of insulin regimen used. In conclusion, type 2 diabetes patients with severe and acute hyperglycemia achieved better glycemic control with the basal-bolus regimen than with sliding-scale insulin, and factors associated with the insulin regimen used could be identified.

Efficacy of basal‐bolus insulin regimens in the inpatient management of non‐critically ill patients with type 2 diabetes: A systematic review and meta‐analysis

“…Overall, the incidence of hypoglycemia in the included studies ranged from 2% to 29%. Six studies reported significantly more episodes of hypoglycemia in patients treated with basal‐bolus therapy than in patients treated with sliding scale . Two retrospective studies reported significantly more episodes of hypoglycemia in SSI‐treated patients than in BBI‐treated patients .…”

“…Five studies were RCTs, 10-14 2 were observational, prospective studies with historical controls, 15,16 and 5 were retrospective studies. [17][18][19][20][21] Characteristics of the included studies are presented in Table 1, including number and mean age of patients, mean admission blood glucose, and mean HbA1C. All studies were done in a non-ICU setting.…”

“…Six studies reported significantly more episodes of hypoglycemia in patients treated with basal-bolus therapy than in patients treated with sliding scale. 13,[15][16][17]21,22 Two retrospective studies reported significantly more episodes of hypoglycemia in SSItreated patients than in BBI-treated patients. 18,21 The remaining 4 studies found no significant difference in hypoglycemic episodes between the 2 treatment regimens.…”

“…13,[15][16][17]21,22 Two retrospective studies reported significantly more episodes of hypoglycemia in SSItreated patients than in BBI-treated patients. 18,21 The remaining 4 studies found no significant difference in hypoglycemic episodes between the 2 treatment regimens. 10,14,16,17 The definition of hypoglycemia was not consistent in all included studies.…”

Virtual Trial of Glycaemic Control Performance and Nursing Workload Assessment in Diabetic Critically Ill Patients

“…Since then, most ICU opts to use TGC even though the target range of glucose control is still being debated over their resulting number of hypoglycaemia, longer period of stay and higher nursing workload [5], [6]. Different type of controls have been reported in many TGC studies [7], [8], and the preferred approach is the sliding-scale protocol [9]. Chase et al, Okabayashi et al, and Lin et al, proposed modelbased protocol with TGC studies as a solution to reduce mortality and hypoglycaemia events [10]- [12].…”