Efficient and safe glycaemic control with basal-bolus insulin therapy during fasting periods in hospitalised patients with type 2 diabetes using decision support technology: a post-hoc analysis.

AIMS: Fasting periods represent a significant challenge for glycaemic control in hospitalised patients. The study aims to evaluate the efficacy and safety of basal-bolus insulin therapy in managing glycaemia during fasting periods in hospitalised patients with type 2 diabetes. MATERIALS AND METHODS: We performed a post-hoc analysis of two prospective, uncontrolled interventional trials that applied electronic decision support system guided basal-bolus (meal-related and correction) insulin therapy. We searched for fasting periods (invasive or diagnostic procedures, medical condition) during inpatient stays. In a mixed-model analysis, patients' glucose levels and insulin doses on days with regular food intake were compared to days with fasting periods. RESULTS: Out of 249 patients, 115 patients (33.9% female, age 68.3±10.3 years, diabetes duration 15.1±10.9 years, BMI 30.1±5.4 kg/m2 , HbA1c 69±20 mmol/mol) had 194 days with fasting periods. Mean daily blood glucose was lower (Modelled difference (ModDiff): -0.5±0.2 mmol/L, p=0.006), and the proportion of glucose values within the target range (3.9-10.0 mmol/L) increased on days with fasting periods compared to days with regular food intake (ModDiff: +0.06±0.02, p=0.005). Glycaemic control on fasting days was driven by a reduction in daily bolus insulin doses (ModDiff: -11.0±0.9 IU, p<0.001), while basal insulin was similar (ModDiff: -1.1±0.6 IU, p=0.082) as compared to non-fasting days. Regarding hypoglycaemic events (BG <3.9 mmol/L), there was no difference between fasting and non-fasting days (χ2 0.9% vs. 1.7%, p=0.174). CONCLUSIONS: When using well titrated basal-bolus insulin therapy in hospitalised patients with type 2 diabetes, the basal insulin dose does not require adjustment during fasting periods to achieve safe glycaemic control, provided meal-related bolus insulin is omitted and correction bolus insulin is tailored to glucose levels. This article is protected by copyright. All rights reserved.