Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial).

TLDR: In this paper, the optimal management of hyperglycemia in non-intensive care unit patients with type 2 diabetes was studied, and a prospective, multicenter, randomized trial was conducted to compare the efficacy and safety of a basal-bolus insulin regimen with that of sliding-scale regular insulin (SSI) in patients with Type 2 diabetes.

Abstract: OBJECTIVE —We sought to study the optimal management of hyperglycemia in non–intensive care unit patients with type 2 diabetes, as few studies thus far have focused on the subject. RESEARCH DESIGN AND METHODS —We conducted a prospective, multicenter, randomized trial to compare the efficacy and safety of a basal-bolus insulin regimen with that of sliding-scale regular insulin (SSI) in patients with type 2 diabetes. A total of 130 insulin-naive patients were randomized to receive glargine and glulisine ( n = 65) or a standard SSI protocol ( n = 65). Glargine was given once daily and glulisine before meals at a starting dose of 0.4 units · kg −1 · day −1 for blood glucose 140–200 mg/dl or 0.5 units · kg −1 · day −1 for blood glucose 201–400 mg/dl. SSI was given four times per day for blood glucose >140 mg/dl. RESULTS —The mean admission blood glucose was 229 ± 6 mg/dl and A1C 8.8 ± 2%. A blood glucose target of P 240 mg/dl. There were no differences in the rate of hypoglycemia or length of hospital stay. CONCLUSIONS —Treatment with insulin glargine and glulisine resulted in significant improvement in glycemic control compared with that achieved with the use of SSI alone. Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the management of non–critically ill, hospitalized patients with type 2 diabetes.