Rabbit 2 Trial - June 24, 2007

Insulin Regimen for Controlling Hyperglycemia in Hospitalized Patients in Medical Wards





Although many studies have looked at glycemic control in patients in the ICU or CCU, few have focused on management of hyperglycemia in patients in medical wards. The RABBIT 2 trial presented by Dr. Dawn D. Smiley, Atlanta, GA, randomized 130 insulin-naïve patients with type 2 diabetes of at least 3 months’ duration hospitalized in the general medical ward to treatment with a basal-bolus regimen of insulin glargine plus glulisine or sliding scale regular insulin (SSRI). The mean blood glucose (BG) level of the patients was 229 (±6) mg/dL and mean A1C level was 8.8% (±2%) at admission. Those who received the basal-bolus regimen achieved greater improvements in BG control, with 66% achieving the target BG of <140 mg/dL, compared with 38% of those who received SSRI. Even with increasing insulin doses, 14% of patients treated with SSRI had persistent hyperglycemia (BG >240 mg/dL). These patients reached target BG within 4 days of switching to the basal-bolus regimen. No differences in the rates of hypoglycemia, mortality, or the length of hospital stay were observed between the 2 treatment groups.


In this study, the starting dose for the basal-bolus regimen was 0.4 U/kg/d for patients with baseline BG between 140 and 200 mg/dL and 0.5 U/kg/d for those with baseline BG >200 mg/dL. Half the dose was administered as glargine and the other half as glulisine prior to meals. SSRI was administered 4 times a day.


193-OR Randomized study of basal bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Presented by Dawn D. Smiley, MD, on Sunday, June 24.