Background and aims:
Current clinical guidelines recommend basal-bolus insulin therapy and the use of clinical decision support systems to achieve glycaemic control in hospitalised patients with hyperglycaemia. The aim of the study was to evaluate glycaemic control using a novel long acting basal insulin in an algorithm driven basal-bolus insulin therapy in hospitalised patients with type 2 diabetes (T2D).

Materials and methods:
Thirty patients with T2D (12 female, age 67 ± 11 years, HbA1c 79 ± 26 mmol/mol, BMI 32 ± 6 kg/m2, diabetes duration 14 ± 11 years, creatinine 1.3 ± 0.5 mg/dL, length of study therapy 8.5 ± 4.5 days) were treated with GlucoTab® - a mobile decision support system providing automated workflow and insulin dosing suggestion to health care professionals. Insulin glargine U300 and insulin glulisine were used for basal-bolus insulin therapy.

Results:
The overall mean blood glucose (BG) value was 8.5 ± 1.5 mmol/L (mean pre-enrolment BG 10.5 ± 3.2 mmol/L). 76.4% of BG measurements were in the range of 3.9-10 mmol/L. BG measurements in the ranges <2.2 mmol/L, <3.9 mmol/L, 10 - <16.7 mmol/L and ≥16.7 mmol/L were observed in 0.1%, 0.9%, 21.0% and 1.7% of all measurements, respectively. Total daily insulin dose was 63.8 ± 39.8 U (bolus insulin dose 34.9 ± 19.9 U, basal insulin dose 29.0 ± 21.0 U). Physicians’ adherence to the algorithm-calculated total daily insulin dose was 97.3% and nurses’ adherence to inject the algorithm-calculated basal and bolus insulin doses was high (99.1% and 95.6%).

Conclusion:
Inpatient glycaemic control using insulin glargine U300 in GlucoTab based basal-bolus insulin therapy could safely be established without modification of the algorithm. Hypoglycaemia rates were similar to even lower as compared to best practice studies.


The study was supported by Sanofi.

Algorithm based basal-bolus insulin therapy for inpatient glycaemic control using a novel long acting insulin analogue