Triple-B (basal-bolus-booster) subcutaneous insulin regimen: a pragmatic approach to managing hospital inpatient hyperglycaemia

2011 ◽  
Vol 28 (6) ◽  
pp. 266-269 ◽  
Author(s):  
NJ Perera ◽  
AJ Harding ◽  
MI Constantino ◽  
L Molyneaux ◽  
M McGill ◽  
...  
Keyword(s):  
Hospital Inpatient ◽  
Insulin Regimen ◽  
Subcutaneous Insulin ◽  
Pragmatic Approach ◽  
Basal Bolus

scholarly journals Addition of a single short-acting insulin bolus to basal insulin-supported oral therapy: a systematic review of data on the basal-plus regimen

2019 ◽  
Vol 7 (1) ◽  
pp. e000679 ◽  
Author(s):  
Jochen Seufert ◽  
Anja Borck ◽  
Peter Bramlage
Keyword(s):  
Basal Insulin ◽  
Fixed Ratio ◽  
Severe Hypoglycemia ◽  
Insulin Regimen ◽  
Premixed Insulin ◽  
Minimal Impact ◽  
Short Acting ◽  
Acting Insulin ◽  
Short Acting Insulin ◽  
Basal Bolus

We summarize here clinical and trial data on a once-daily administration of a single bolus to the meal with the largest expected postprandial glucose excursion (basal-plus), and comment on its clinical utility in the treatment of type 2 diabetes. A PubMed search of data published until September 2018 was taken into consideration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eighteen reports representing 15 studies were identified (age: 18–80 years; 50–890 patients; follow-up: 8 days to 60 weeks). Data suggest basal-plus is efficacious for improving glycemic control, with a low incidence of (severe) hypoglycemia and minor increases in bodyweight. The timing of short-acting insulin administration and use of different monitoring/titration approaches appear to have minimal impact. When compared with premixed insulin, basal-plus results in largely comparable outcomes. Compared with basal-bolus, it may result in non-inferior glycemic improvements with less weight gain, less hypoglycemia and fewer daily injections. A basal insulin/glucagon-like peptide-1 receptor agonist fixed ratio combination may offer several advantages over the basal-plus regimen, at the cost of gastrointestinal side effects. We conclude that the stepwise introduction of short-acting insulin via the basal-plus strategy represents a viable alternative to a full basal-bolus regimen and may help to overcome barriers associated with multiple injections and anticipated complexity of the insulin regimen.

scholarly journals Comparison of an Electronic Glycemic Management System Versus Provider-Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting

2016 ◽  
Vol 11 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Joseph Aloi ◽  
Bruce W. Bode ◽  
Jagdeesh Ullal ◽  
Paul Chidester ◽  
Raymie S. McFarland ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Management System ◽  
Standard Treatment ◽  
Hospital Setting ◽  
Insulin Regimen ◽  
Therapy Outcomes ◽  
System Versus ◽  
Bolus Insulin ◽  
Basal Bolus ◽  
Glycemic Management

Background: American Diabetes Association (ADA) guidelines recommend a basal bolus correction insulin regimen as the preferred method of treatment for non–critically ill hospitalized patients. However, achieving ADA glucose targets safely, without hypoglycemia, is challenging. In this study we evaluated the safety and efficacy of basal bolus subcutaneous (SubQ) insulin therapy managed by providers compared to a nurse-directed Electronic Glycemic Management System (eGMS). Method: This retrospective crossover study evaluated 993 non-ICU patients treated with subcutaneous basal bolus insulin therapy managed by a provider compared to an eGMS. Analysis compared therapy outcomes before Glucommander (BGM), during Glucommander (DGM), and after Glucommander (AGM) for all patients. The blood glucose (BG) target was set at 140-180 mg/dL for all groups. The safety of each was evaluated by the following: (1) BG averages, (2) hypoglycemic events <40 and <70 mg/dL, and (3) percentage of BG in target. Result: Percentage of BG in target was BGM 47%, DGM 62%, and AGM 36%. Patients’ BGM BG average was 195 mg/dL, DGM BG average was 169 mg/dL, and AGM BG average was 174 mg/dL. Percentage of hypoglycemic events <70 mg/dL was 2.6% BGM, 1.9% DGM, and 2.8% AGM treatment. Conclusion: Patients using eGMS in the DGM group achieved improved glycemic control with lower incidence of hypoglycemia (<40 mg/dL and <70 mg/dl) compared to both BGM and AGM management with standard treatment. These results suggest that an eGMS can safely maintain glucose control with less hypoglycemia than basal bolus treatment managed by a provider.

scholarly journals Long-term comparison of human insulin analogue B10Asp and soluble human insulin in IDDM patients on a basal/bolus insulin regimen

Diabetologia ◽  
1995 ◽  
Vol 38 (5) ◽  
pp. 592-598 ◽  
Author(s):  
F. S. Nielsen ◽  
L. N. J�rgensen ◽  
M. Ipsen ◽  
A. I. Voldsgaard ◽  
H. -H. Parving
Keyword(s):  
Human Insulin ◽  
Insulin Analogue ◽  
Insulin Regimen ◽  
Bolus Insulin ◽  
Basal Bolus

scholarly journals Hypoglycemia Incidence and Factors Associated in a Cohort of Patients With Type 2 Diabetes Hospitalized in General Ward Treated With Basal Bolus Insulin Regimen Assessed by Continuous Glucose Monitoring

2019 ◽  
Vol 14 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Ana María Gómez ◽  
Angélica Imitola Madero ◽  
Diana Cristina Henao Carrillo ◽  
Martín Rondón ◽  
Oscar Mauricio Muñoz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
General Ward ◽  
Insulin Regimen ◽  
Factors Associated ◽  
Bolus Insulin ◽  
Mean Glucose ◽  
Basal Bolus

Introduction: Continuous glucose monitoring (CGM) is a better tool to detect hyper and hypoglycemia than capillary point of care in insulin-treated patients during hospitalization. We evaluated the incidence of hypoglycemia in patients with type 2 diabetes (T2D) treated with basal bolus insulin regimen using CGM and factors associated with hypoglycemia. Methods: Post hoc analysis of a prospective cohort study. Hypoglycemia was documented in terms of incidence rate and percentage of time <54 mg/dL (3.0 mmol/L) and <70 mg/dL (3.9 mmol/L). Factors evaluated included glycemic variability analyzed during the first 6 days of basal bolus therapy. Results: A total of 34 hospitalized patients with T2D in general ward were included, with admission A1c of 9.26 ± 2.62% (76.8 ± 13 mmol/mol) and mean blood glucose of 254 ± 153 mg/dL. There were two events of hypoglycemia below 54 mg/dL (3.0 mmol/L) and 11 events below 70 mg/dL (3.9 mmol/L) with an incidence of hypoglycemic events of 0.059 and 0.323 per patient, respectively. From second to fifth day of treatment the percentage of time in range (140-180 mg/dL, 7.8-10.0 mmol/L) increased from 72.1% to 89.4%. Factors related to hypoglycemic events <70 mg/dL (3.9 mmol/L) were admission mean glucose (IRR 0.86, 95% CI 0.79, 0.95, P < .01), glycemic variability measured as CV (IRR 3.12, 95% CI 1.33, 7.61, P < .01) and SD, and duration of stay. Conclusions: Basal bolus insulin regimen is effective and the overall incidence of hypoglycemia detected by CGM is low in hospitalized patients with T2D. Increased glycemic variability as well as the decrease in mean glucose were associated with events <70 mg/dL (3.9 mmol/L).

The GesTIO protocol experience: safety of a standardized order set for subcutaneous insulin regimen in elderly hospitalized patients

2017 ◽  
Vol 29 (6) ◽  
pp. 1087-1093 ◽  
Author(s):  
Alessandro Franchin ◽  
Alberto Maran ◽  
Daniela Bruttomesso ◽  
Maria L. Corradin ◽  
Francesco Rossi ◽  
...  
Keyword(s):  
Hospitalized Patients ◽  
Insulin Regimen ◽  
Subcutaneous Insulin ◽  
Elderly Hospitalized Patients ◽  
Order Set

scholarly journals Efficacy And Safety of Empagliflozin Continuation in Patients With Type 2 Diabetes Hospitalised For Acute Decompensated Heart Failure

2021 ◽  
Author(s):  
Luis M Pérez-Belmonte ◽  
Michele Ricci ◽  
Jaime Sanz-Cánovas ◽  
Mercedes Millán-Gómez ◽  
Julio Osuna-Sánchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Urine Output ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Insulin Regimen ◽  
Propensity Matching ◽  
Bolus Insulin ◽  
Basal Bolus

Abstract Background: Sodium−glucose cotransporter 2 inhibitors have been shown to reduce hospitalisations for acute decompensated heart failure in patients with and without type 2 diabetes. However, there is little evidence on their use in hospitalised patients. This work aims to analyse the glycaemic and clinical efficacy and safety of empagliflozin continuation in patients with type 2 diabetes hospitalised for acute decompensated heart failure.Methods: This real-world study included non-critically ill patients with diabetes hospitalised for acute decompensated heart failure and treated with empagliflozin for at least three months prior to the hospitalisation between 2017 and 2020. According to our in-hospital antihyperglycaemic protocol, patients could be treated with two possible regimens: a basal-bolus insulin regimen and an empagliflozin-basal insulin regimen. Our primary endpoints were difference in glycaemic control, as measured via mean daily blood glucose level, and differences in the visual analogue scale dyspnoea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints were also analysed. A propensity matching analysis was used to match a patient on one regimen with a patient on the other regimen. The probability of starting the regimes was estimated with a logistic regression model including variables that could have affected treatment assignment or outcomes as independent variablesResults: After a propensity matching analysis, 91 patients were included in each group. There were no differences in mean blood glucose levels (152.1 ± 17.8 vs 155.2 ± 19.7 mg/dl, p=0.289). At discharge, NT-proBNP levels were lower and cumulative urine output greater in the empagliflozin group versus the basal-bolus insulin group (1,652 ± 501 vs 2,101 ± 522 pg/mL, p=0.032 and 16,100 ± 1,510 vs 13,900 ± 1,220 ml, p=0.037, respectively). Patients who continued empagliflozin had a lower total number of hypoglycaemic episodes (36 vs 64, p<0.001). No differences were observed in adverse events, length of hospital stay, or in-hospital deaths.Conclusions: For patients with acute heart failure, an in-hospital antihyperglycaemic regimen that includes continuation of empagliflozin achieved effective glycaemic control, lower NT-proBNP, and greater urine output. It was also safer, as it reduced hypoglycaemic episodes without increasing other safety endpoints.

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