scholarly journals Inpatient hyperglycemia management: the opportunities of a new basal insulin

2016 ◽  
Vol 10 (2) ◽  
pp. 103 ◽  
Author(s):  
Natalino Simioni
Keyword(s):  
Insulin Therapy ◽  
Basal Insulin ◽  
Hospital Setting ◽  
Insulin Analogues ◽  
Diabetic Patients ◽  
Potential Clinical Benefit ◽  
Sliding Scale ◽  
Bolus Insulin ◽  
Basal Bolus

The management of hospitalized diabetic patients for any cause is often difficult and affected not only by the comorbidities of the patient but also by the hospital setting. It is well known that at the admission the antidiabetic drugs should be discontinued on behalf of insulin therapy with insulin analogues, as a function of a basal-bolus insulin approach according to the phenotype of the patient, type of nutrition (enteral or parenteral rather than oral), or concomitant hyperglycemic therapy (<em>e.g.</em>, steroid). The average stay of diabetic patients hospitalized for any cause is significantly correlated with both the number of hypoglycemia and hyperglycemia. Compared to patients treated with sliding scale patients using a custom algorithm show a significant reduction in the number of hypoglycemia and hyperglycemia episodes and in the length of stay. We analyze the clinical profile of a novel basal insulin, degludec, and explore the potential clinical benefit for diabetic inpatient. The continuation of insulin therapy at home in the immediate post-hospitalization (if necessary), also correlates with a reduction in the rate of re-hospitalization, which combined with close follow-up diabetes can result in a reduction of chronic complications.

scholarly journals Insulin degludec/insulin aspart is the first co-formulation of basal and prandial insulin analogues

2014 ◽  
Vol 17 (4) ◽  
pp. 108-119
Author(s):  
Ivan Ivanovich Dedov ◽  
Marina Vladimirovna Shestakova
Keyword(s):  
Glycemic Control ◽  
Insulin Therapy ◽  
Insulin Aspart ◽  
Basal Insulin ◽  
Diabetes Management ◽  
Insulin Analogues ◽  
Insulin Degludec ◽  
Diabetic Patients ◽  
Prandial Insulin ◽  
Basal Bolus

Achievement of glycemic control is the major therapeutic aim to prevent or delay the onset and progression of diabetes related complications. Insulin therapy represents a cornerstone in the treatment of diabetes and has been used widely for achieving glycemic goals. The aim for insulin therapy is to mimic the physiological profile of insulin secretion seen in nondiabetic patients. Development of the insulin analogs has offered new opportunities in the diabetes management to achieve greater safety and tolerability of diabetes treatment. Insulin degludec/insulin aspart(IDegAsp) (Ryzodeg?, Novo Nordisk, Denmark) is the first soluble co-formulation of 70% ultra-long acting insulin degludec and 30% rapid-acting prandial insulin aspart, providing both basal insulin coverage and a prandial insulin bolus in a single injection. This review discusses data regarding the efficacy, safety, tolerability and clinical benefits of IDegAsp. According to the clinical development program IDegAspprovides an achievement of similar glycemic control with superiority in lowering FPG with using less number of injections and lower daily insulin dose, and also associated with numerically lower rates of confirmed and nocturnal confirmed hypoglycaemia in comparison with premixed or basal insulin analogues, as well as a basal component for basal?bolus therapy with supplementary mealtime insulin aspart.Trial results suggest that IDegAspQD or BID maybe an appropriate and reasonable option for initiating insulin therapy in type 1 and type 2 diabetic patients inadequately controlled on maximal doses of oral antidiabetic drugs,and also a simple alternative to basal?bolus treatment in patients who require intensification of insulin therapy, especially when adherence to more complex regimens is challenging.

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.

Basal-Bolus Insulin Therapy May Not Be the Optimal Strategy in a "Real-World" Hospital Setting for Inpatient Hyperglycemia Management

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1256-P
Author(s):  
ARCHANA R. SADHU ◽  
BHARGAVI PATHAM ◽  
AISHA VADHARIYA ◽  
MICHAEL L. JOHNSON
Keyword(s):  
Insulin Therapy ◽  
Real World ◽  
Optimal Strategy ◽  
Hospital Setting ◽  
Bolus Insulin ◽  
Basal Bolus

scholarly journals Management of Type 2 Diabetes – Methods for Addition of Prandial to Basal Insulin

2014 ◽  
Vol 10 (2) ◽  
pp. 124 ◽  
Author(s):  
Helena W Rodbard ◽  
Boris Karolicki ◽  
◽  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Basal Insulin ◽  
Multiple Dose ◽  
Treatment Guidelines ◽  
Clinical Inertia ◽  
Dose Titration ◽  
Bolus Insulin ◽  
Basal Bolus

As glycaemic control deteriorates with the progression of type 2 diabetes, treatment guidelines advocate starting basal insulin therapy, and then progressing to a basal–bolus regimen as needed. Nevertheless, although timely intensification of therapy is important to minimise the risk of diabetic complications, considerable clinical inertia exists, not only in the initiation of insulin but also in the progression to multiple-dose insulin regimens. One barrier has been the lack of guidance about how to make the transition from basal-only to basal–bolus insulin therapy. In this review, we discuss how data from the recent FullSTEP study, along with other randomised studies, will help to bridge this gap. Prandial boluses can be added to basal insulin in a stepwise manner, using a straightforward, patient-led dose titration approach and simple estimation of which meal to add the initial prandial bolus to. Reducing the complexity of progression to multiple-dose insulin regimens and empowering patients will lessen the burden on clinicians, improve treatment satisfaction and facilitate timely implementation of treatment guidelines.

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

2016 ◽  
Vol 11 (1) ◽  
pp. 17-19
Author(s):  
Silvia Leitgeb ◽  
Julia K. Mader
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Management System ◽  
Positive Impact ◽  
Hospital Setting ◽  
Before And After ◽  
Bolus Insulin ◽  
Basal Bolus ◽  
Glycemic Management

Safety and efficacy of a nurse-directed electronic glycemic management system (eGMS) in comparison to basal-bolus subcutaneous insulin therapy managed by providers has been evaluated recently by Aloi et al. They included 993 non–critically ill patients across 9 different hospitals in a retrospective observational crossover study and compared mean blood glucose, number of hypoglycemic events <40 mg/dl and <70 mg/dl and the percentage of blood glucose in target (140-180 mg/dl) before, during and after the use of eGMS. Conclusion was that eGMS can lead to better glycemic control with less hypoglycemic events compared to provider managed basal-bolus insulin therapy (before and after eGMS). Although some limitations exist, the authors made a strong case that eGMS has positive impact on glycemic control in hospitalized patients with diabetes.

scholarly journals Management of Type 2 Diabetes – Methods for Addition of Prandial to Basal Insulin

2014 ◽  
Vol 10 (02) ◽  
pp. 132
Author(s):  
Helena W Rodbard ◽  
Boris Karolicki ◽  
◽  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Basal Insulin ◽  
Multiple Dose ◽  
Treatment Guidelines ◽  
Clinical Inertia ◽  
Dose Titration ◽  
Bolus Insulin ◽  
Basal Bolus

As glycaemic control deteriorates with the progression of type 2 diabetes, treatment guidelines advocate starting basal insulin therapy, and then progressing to a basal–bolus regimen as needed. Nevertheless, although timely intensification of therapy is important to minimise the risk of diabetic complications, considerable clinical inertia exists, not only in the initiation of insulin but also in the progression to multiple-dose insulin regimens. One barrier has been the lack of guidance about how to make the transition from basal-only to basal–bolus insulin therapy. In this review, we discuss how data from the recent FullSTEP study, along with other randomised studies, will help to bridge this gap. Prandial boluses can be added to basal insulin in a stepwise manner, using a straightforward, patient-led dose titration approach and simple estimation of which meal to add the initial prandial bolus to. Reducing the complexity of progression to multiple-dose insulin regimens and empowering patients will lessen the burden on clinicians, improve treatment satisfaction and facilitate timely implementation of treatment guidelines.

scholarly journals Outcomes of “Real World” Insulin Strategies in the Management of Hospital Hyperglycemia

2021 ◽  
Author(s):  
Archana R Sadhu ◽  
Bhargavi Patham ◽  
Aisha Vadhariya ◽  
Soumya G Chikermane ◽  
Michael L Johnson
Keyword(s):  
Insulin Therapy ◽  
Real World ◽  
Glucose Control ◽  
Initial Therapy ◽  
The Real ◽  
Sliding Scale ◽  
Long Acting ◽  
Bolus Insulin ◽  
Mean Glucose ◽  
Basal Bolus

Abstract Context Guidelines recommend scheduled long acting basal and short acting bolus insulin several times daily to manage inpatient hyperglycemia. In the “real world”, insulin therapy is complicated, with limited data on comparative effectiveness of different insulin strategies. Objective Evaluate the association of different insulin strategies with glucose control and hospital outcomes, after adjustment for patient and physician factors that influence choice of therapy. Design Retrospective, observational. Setting Academic hospital. Patients Non-critically ill hospitalized medical/surgical patients (n=4,558) receiving subcutaneous insulin ≥75% of the admission. Interventions Insulin therapy was grouped into 3 strategies within the first 48 hours: basal-bolus (BB: scheduled long and short/rapid n=2,358), sliding scale (SS: short/rapid acting n=1,855), or basal only (BO: long only: n=345). Main Outcome Measure(s) Glucose control: hypo-, hyper-, euglycemic days, mean glucose. Hospitalization: mortality, length of stay (LOS), readmissions. Results Initial therapy with BB was associated with more hypoglycemic (2.40 (CI:2.04,2.82) (P&lt; 0.001)) and fewer euglycemic days (0.90 (CI:0.85,0.97) (P=0.003)) than SS, whereas BO was associated with fewer hyperglycemic days ((0.70 (0.62,0.79) (P&lt;0.001)), lower mean glucose (-18.03 (CI:-22.46, -12.61) (P&lt; 0.001)) and more euglycemic days (1.22 (CI:1.09,1.37), (P&lt; 0.001)) compared to SS. No difference in mortality, LOS and readmissions was found. However, decreased LOS was observed in the subgroup with a medical DRG (0.93 (CI:0.89,0.97) (P&lt;0.001)). Conclusion BO had a more favorable hyperglycemia profile than SS. BB, on the other hand showed worse glycemic control as compared to SS. In the real-world hospital, BO may be a simpler and more effective insulin strategy.

Sign in / Sign up

Export Citation Format

Share Document