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.