Efficient and safe glycaemic control with basal-bolus insulin therapy during fasting periods in hospitalized patients with type 2 diabetes using decision support technology: A post hoc analysis

被引：2

作者：

Hochfellner, Daniel A. ^{[1
]}

Rainer, Raphael ^{[1
]}

Ziko, Haris ^{[1
]}

Aberer, Felix ^{[1
]}

Simic, Amra ^{[1
]}

Lichtenegger, Katharina M. ^{[1
]}

Beck, Peter ^{[2
,3
]}

Donsa, Klaus ^{[3
]}

Pieber, Thomas R. ^{[1
,3
]}

Fruhwald, Friedrich M. ^{[4
]}

Rosenkranz, Alexander R. ^{[5
]}

Kamolz, Lars-Peter ^{[6
]}

Baumann, Petra M. ^{[1
]}

Mader, Julia K. ^{[1
]}

Plank, Johannes ^{[7
]}

机构：

[1] Med Univ Graz, Dept Internal Med, Div Endocrinol & Diabetol, Auenbruggerpl 15, A-8036 Graz, Austria

[2] Decide Clin Software GmbH, Graz, Austria

[3] Joanneum Res GmbH, HLTH, Graz, Austria

[4] Med Univ Graz, Dept Internal Med, Div Cardiol, Graz, Austria

[5] Med Univ Graz, Dept Internal Med, Div Nephrol, Graz, Austria

[6] Med Univ Graz, Dept Surg, Div Plast Reconstruct & Aesthet Surg, Graz, Austria

[7] Med Univ Graz, Dept Internal Med, Div Gastroenterol & Hepatol, Graz, Austria

来源：

DIABETES OBESITY & METABOLISM | 2021年 / 23卷 / 09期

关键词：

basal insulin; clinical trial; continuous glucose monitoring (CGM); insulin therapy; type; 2; diabetes; MANAGEMENT; WORKFLOW; ORDERS;

D O I：

10.1111/dom.14458

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aim To evaluate the efficacy and safety of basal-bolus insulin therapy in managing glycaemia during fasting periods in hospitalized patients with type 2 diabetes. Materials and Methods We performed a post hoc analysis of two prospective, uncontrolled interventional trials that applied electronic decision support system-guided basal-bolus (meal-related and correction) insulin therapy. We searched for fasting periods (invasive or diagnostic procedures, medical condition) during inpatient stays. In a mixed model analysis, patients & apos; glucose levels and insulin doses on days with regular food intake were compared with days with fasting periods. Results Out of 249 patients, 115 patients (33.9% female, age 68.3 +/- 10.3 years, diabetes duration 15.1 +/- 10.9 years, body mass index 30.1 +/- 5.4 kg/m(2), HbA1c 69 +/- 20 mmol/mol) had 194 days with fasting periods. Mean daily blood glucose (BG) was lower (modelled difference [ModDiff]: -0.5 +/- 0.2 mmol/L, P = .006), and the proportion of glucose values within the target range (3.9-10.0 mmol/L) increased on days with fasting periods compared with days with regular food intake (ModDiff: +0.06 +/- 0.02, P = .005). Glycaemic control on fasting days was driven by a reduction in daily bolus insulin doses (ModDiff: -11.0 +/- 0.9 IU, P < .001), while basal insulin was similar (ModDiff: -1.1 +/- 0.6 IU, P = .082) compared with non-fasting days. Regarding hypoglycaemic events (BG < 3.9 mmol/L), there was no difference between fasting and non-fasting days (chi(2) 0.9% vs. 1.7%, P = .174). Conclusions When using well-titrated basal-bolus insulin therapy in hospitalized patients with type 2 diabetes, the basal insulin dose does not require adjustment during fasting periods to achieve safe glycaemic control, provided meal-related bolus insulin is omitted and correction bolus insulin is tailored to glucose levels.

引用

页码：2161 / 2169

页数：9

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