Effective adverse event reduction with bolus-basal versus sliding scale insulin therapy in patients with diabetes during conventional hospitalization: Systematic review and meta-analysis.

Autor:	Gómez Cuervo C; Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: cova.gomez.cuervo@gmail.com., Sánchez Morla A; Servicio de Urgencias, Hospital Universitario 12 de Octubre, Madrid, España., Pérez-Jacoiste Asín MA; Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España., Bisbal Pardo O; Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España., Pérez Ordoño L; Servicio de Urgencias, Hospital Universitario 12 de Octubre, Madrid, España., Vila Santos J; Servicio de Urgencias, Hospital Universitario 12 de Octubre, Madrid, España.
Jazyk:	English; Spanish; Castilian
Zdroj:	Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion [Endocrinol Nutr] 2016 Apr; Vol. 63 (4), pp. 145-56. Date of Electronic Publication: 2016 Jan 28.
DOI:	10.1016/j.endonu.2015.11.008
Abstrakt:	Introduction: The aim of this review was to assess the effectiveness to reduce clinical adverse events and safety of insulin administered in basal-bolus-corrector or basal-corrector regimens (BB) versus a sliding scale scheme (SS) in patients with diabetes or newly diagnosed hyperglycemia admitted to a conventional (not critical) medical or surgical hospital ward. Method: A Medline search was conducted. The Odds ratio was the main summary measure. A random effects model with the Mantel-Haenszel procedure was used. Results: A total of 957 citations were collected, of which nine were finally included in the systematic review. Patients in the BB group had better blood glucose control than those with SS. Overall, there was a nonsignificant trend to a lower risk of adverse events in the BB as compared to the SS group (OR 0.67 [95% CI 0.22 to 2.04], [I(2)=71%]). There was a nonsignificant trend to an increased risk of hypoglycemia in the BB group (OR 2.29 [95% CI 0.50 to 10.49] [I(2)=70%]). Conclusion: Despite its benefit for glycemic control during hospitalization, this review did not show that use of the BB scheme decreases clinical events in patients hospitalized in a conventional ward. Because of heterogeneity of the results, we think that clinical trials are needed addressing its effect in patient subgroups in which the BB scheme may be used safely and with longer follow-up periods. (Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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