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Use of basal/bolus insulin in hospitalized patients with type 2 diabetes has become the standard of care during the past decade. However, optimal blood glucose (BG) targets and best use of supplemental sliding-scale insulin (SSI) still are evolving. Potential barriers to adding SSI to basal/bolus regimens are increased treatment burden (more insulin injections and calculations) and iatrogenic hypoglycemia.
In a randomized noninferiority study from Emory University, 224 hospitalized patients with longstanding type 2 diabetes received either intensive SSI (at BG >140 mg/dL) or nonintensive SSI (at BG >260 mg/dL) before meals and at bedtime. Both groups received basal/bolus insulin; both the starting dose and subsequent changes were specified b…