Vol 10, No 2 (2021)
Research paper
Published online: 2021-02-16

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Effect of basal insulin therapy with glargine U300 versus basal bolus insulin therapy in hospitalized patients with type 2 diabetes. Real-world study from India

Asis Mitra1, Saswati Ray2, Sushma Jayan3
Clin Diabetol 2021;10(2):180-187.

Abstract

Background. Basal-bolus insulin therapy is the most widely accepted method of glycemic control in non-critically ill patients with T2DM. In this regimen glargine U100 is the most commonly used basal insulin. American Diabetes Association recommends either basal or basal bolus therapy for patients with type 2 diabetes mellitus admitted in general medical and surgical ward with ideal glycemic target ranging between 140–180 mg/dL by estimating four or 6 hourly capillary blood glucose per day. Insulin glargine U300 is a second generation long acting insulin analogue, which has  a prolonged pharmacokinetic /pharmacodynamic profile compared to insulin glargine U100 resulting in glucose lowering activity exceeding 24 hours.
Aim. To assess the efficacy and safety of basal insulin regimen (glargine U300) compared to a basal-bolus insulin regimen  in patients with type 2 diabetes.
Methods. A prospective single centred parallel group study comparing the efficacy and safety of basal insulin regimen with basal-bolus insulin regimen. A total of 60 patients with type 2 diabetes mellitus admitted in general medical and surgical ward for elective surgery and medical emergency were randomized to either of the two regimens. The baseline glycaemic parameters were assessed by capillary blood glucose testing thrice before meal and at bedtime with a target capillary blood glucose (CBG) between 140–180 mg/dL. All pa-tients were followed up for seven days.
Results. The number of CBG readings within the target range were higher in basal insulin monotherapy (glargine U300) compared to basal-bolus regimen using (glargine U100 and regular human insulin) which was statistically significant. The incidence of hypoglycaemia was lower in the basal insulin regimen. Fewer units of insulin were required in the basal insulin regimen with lower glycaemic variability as compared to basal-bolus regimen.
Conclusion. Glargine U 300 monotherapy as a basal insulin is non-inferior to basal- bolus therapy in non-critically ill hospitalised patients in glycaemic control, with fewer incidences of hypoglycaemia, less amount of insulin requirement to achieve target capillary blood glucose level and lower glycaemic variability. 

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References

  1. Umpierrez GE, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007; 30(9): 2181–2186.
  2. American Diabetes Association. Economic Costs of Diabetes in the U.S. American Diabetes Association Diabetes Care . 2018; 41(5): 917–928.
  3. Frisch A, Chandra P, Smiley D, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010; 33(8): 1783–1788.
  4. Pasquel FJ, Spiegelman R, McCauley M, et al. Hyperglycemia during total parenteral nutrition: an important marker of poor outcome and mortality in hospitalized patients. Diabetes Care. 2010; 33(4): 739–741.
  5. Davidson P, Kwiatkowski CA, Wien M. Management of Hyperglycemia and Enteral Nutrition in the Hospitalized Patient. Nutr Clin Pract. 2015; 30(5): 652–659.
  6. Pleva M, Mirtallo JM, Steinberg SM. Hyperglycemic events in non-intensive care unit patients receiving parenteral nutrition. Nutr Clin Pract. 2009; 24(5): 626–634.
  7. Pancorbo-Hidalgo PL, García-Fernandez FP, Ramírez-Pérez C. Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs. 2001; 10(4): 482–490.
  8. McCowen K, Malhotra A, Bistrian B. Stress-Induced hyperglycemia. Critical Care Clinics. 2001; 17(1): 107–124.
  9. ANDREWS R, WALKER B. Glucocorticoids and insulin resistance: old hormones, new targets. Clinical Science. 1999; 96(5): 513.
  10. Marathe CS, Rayner CK, Bound M, et al. Small intestinal glucose exposure determines the magnitude of the incretin effect in health and type 2 diabetes. Diabetes. 2014; 63(8): 2668–2675.
  11. Korytkowski MT, Salata RJ, Koerbel GL, et al. Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial. Diabetes Care. 2009; 32(4): 594–596.
  12. Cook CB, Castro JC, Schmidt RE, et al. Diabetes care in hospitalized noncritically ill patients: More evidence for clinical inertia and negative therapeutic momentum. J Hosp Med. 2007; 2(4): 203–211.
  13. American Diabetes Association. Diabetes Care in the Hospital. Diabetes Care. 2020; 43(Suppl 1): S193–S202.
  14. Pasquel F, Lansang M, Khowaja A, et al. A randomized controlled trial comparing glargine U300 and glargine U100 for the inpatient management of medicine and surgery patients with type 2 diabetes: glargine U300 hospital trial. .
  15. Ghosh S, Ghosh R. Glargine-300: An updated literature review on randomized controlled trials and real-world studies. World J Diabetes. 2020; 11(4): 100–114.
  16. Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007; 30(9): 2181–2186.
  17. Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011; 34(2): 256–261.
  18. Smiley D, Umpierrez GE, Hermayer K, et al. Differences in inpatient glycemic control and response to subcutaneous insulin therapy between medicine and surgery patients with type 2 diabetes. J Diabetes Complications. 2013; 27(6): 637–641.
  19. Suh S, Kim JH. Glycemic variability: how do we measure it and why is it important? Diabetes Metab J. 2015; 39(4): 273–282.