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Observational studies in general surgery patients in noncritical settings have suggested that hyperglycemia is associated with perioperative complications and mortality. Secondary to changes in oral intake during the perioperative period, oral antidiabetic medications traditionally are withheld and replaced with sliding-scale insulin (SSI) therapy.
U.S. researchers conducted a three-center trial to compare basal-bolus insulin therapy to SSI in general surgery patients with type 2 diabetes. Oral antidiabetic medications were discontinued on admission. Patients randomized to basal-bolus therapy received total daily doses (TDDs) of 0.5 units/kg (half as insulin glargine [Lantus] once daily and half as insulin glulisine [Apidra] given before mea…