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Hochfellner, DA; Rainer, R; Ziko, H; Aberer, F; Simic, A; Lichtenegger, KM; Beck, P; Donsa, K; Pieber, TR; Fruhwald, FM; Rosenkranz, AR; Kamolz, LP; Baumann, PM; Mader, JK; Plank, J.
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.
Diabetes Obes Metab. 2021; 23(9):2161-2169 Doi: 10.1111/dom.14458
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Führende Autor*innen der Med Uni Graz
Hochfellner Daniel
Mader Julia
Co-Autor*innen der Med Uni Graz
Aberer Felix
Baumann Petra Martina
Fruhwald Friedrich
Kamolz Lars-Peter
Lichtenegger Katharina
Pieber Thomas
Rosenkranz Alexander
Simic Amra
Ziko Haris

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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' 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/m2 , 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 (χ2 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.
Find related publications in this database (using NLM MeSH Indexing)
Aged - administration & dosage
Blood Glucose - administration & dosage
Diabetes Mellitus, Type 2 - drug therapy
Fasting - administration & dosage
Female - administration & dosage
Glycated Hemoglobin A - analysis
Glycemic Control - administration & dosage
Humans - administration & dosage
Hypoglycemic Agents - administration & dosage
Insulin - administration & dosage
Male - administration & dosage
Middle Aged - administration & dosage
Prospective Studies - administration & dosage

Find related publications in this database (Keywords)
basal insulin
clinical trial
continuous glucose monitoring (CGM)
insulin therapy
type 2 diabetes
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