Effect of basal insulin therapy with glargine U300 versus basal-bolus insulin therapy in hospitalized patients with type 2 diabetes. Real-world study from India

Abstract

Background. Basal-bolus insulin therapy is the most widely accepted method of glycemic control in noncritically ill patients with T2DM [1]. in this regimen glargine U100 is the most commonly used basal insulin. American Diabetes Association recommends either basal or basal bolus therapy for patients with type 2 diabetes mellitus admitted in general medical and surgical ward with ideal glycemic target ranging between 140-180 mg/dL by estimating four or 6 hourly capillary blood glucose per day. insulin glargine U300 is a second generation long acting insulin analogue, which has a prolonged pharmacokinetic /pharmacodynamic profile compared to insulin glargine U100 resulting in glucose lowering activity exceeding 24 hours. Aim. To assess the efficacy and safety of basal insulin regimen (glargine U300) compared to a basal-bolus insulin regimen in patients with type 2 diabetes. Methods. A prospective single centred parallel group study comparing the efficacy and safety of basal insulin regimen with basal-bolus insulin regimen. A total of 60 patients with type 2 diabetes mellitus admitted in general medical and surgical ward for elective surgery and medical emergency were randomized to either of the two regimens. The baseline glycemic parameters were assessed by capillary blood glucose testing thrice before meal and at bedtime with a target capillary blood glucose (CBg) between 140-180 mg/dl. All patients were followed up for seven days. results. The number of CBg readings within the target range were higher in basal insulin monotherapy (glargine U300) compared to basal-bolus regimen using (glargine U100 and regular human insulin) which was statistically significant. The incidence of hypoglycemia was lower in the basal insulin regimen. Fewer units of insulin were required in the basal insulin regimen with lower glycemic variability as compared to basal-bolus regimen. Conclusion. glargine U 300 monotherapy as a basal insulin is non-inferior to basal- bolus therapy in noncritically ill hospitalised patients in glycemic control, with fewer incidences of hypoglycemia, less amount of insulin requirement to achieve target capillary blood glucose level and lower glycemic variability.