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Authors : Basma Beiram
Abstract : The objective of the present work is to develop best practice for enabling targeted glycemic control in the medical and surgical setting considering the multiple factors contributing to hypo/hyperglycemia. A randomized trial comparing the safety and efficacy of a basal-bolus (BB) insulin regimen with glargine insulin once daily and aspart insulin before meals (n = 60) to sliding scale regular insulin (SSI) with regular insulin four times daily (n = 90) in patients with type 2 diabetes mellitus admitted to the medical and general surgery ward. Outcomes included differences in daily blood glucose, hospital length of stay and hypoglycemia/hyperglycemia occurrences. There was a 27% and 15% reduction in the average length of stay in the medical and surgical wards respectively post implementation of new regimen. Secondly 68% and 902% reductions in the hypoglycemic episodes per 100 patient days in the medical and surgical ward respectively post implementation of the new regimen. Basal-bolus treatment with glargine insulin once daily plus aspart insulin before meals improved glycemic control and reduced hospital complications compared with SSI in general surgery patients. Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the hospital management of medical and surgery patients with type 2 diabetes.

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