Insulin Schemes for Type 2 Diabetes Control

On the first 4 to 6 h, the use of NPH insulin present a pronounced action peak on the postprandial glucose metabolism, and the rest of its basal action last 12 to 18 h, its cover the postprandial requirements of the first two meals of the day (breakfast and lunch) administering 2/3 of the total dose, and the requirements for the dinner with 1/3 of the total dose at the night. This is considered a good scheme for handling hyperglycemia, and its possible to have less hypoglycemia episodes, which are possible if an ultra-rapid-acting insulin is added and adequate intake is not performed due to multiple factors related to hospitalization.

Today it is uncertain whether there is any clear benefit of using Glargine plus Lantus insulin over NPH insulin in hospitalized patients with type 2 diabetes. Currently, both Glargine and NPH based regimen is practiced in inpatient hospital facilities. Current practice of inpatient insulin regimen is based on the physicians familiarity with a particular insulin type and personal preference rather than evidenced based knowledge. Glargine plus ultrafast insulin are two types of insulin that are more expensive compared to NPH with incidental benefits in hospitalized patients. There are reports in the literature about the incidence of hypoglycemia with this scheme. The current research proposal is to compare these two schemes in the treatment of hospitalized patients with diabetes in a hospital of the second level of care in Mexico.

Inclusion criteria

• Patients between 18 and 100 years old.
• History of type 2 diabetes mellitus (DM2) or that upon admission is diagnosed by values of glycated haemoglobin (HbA1) > 6.5%
• Fasting central glucose before randomization between 140mg/dl and 400mg/dl
• Non-critical patients hospitalized in the service of Internal Medicine (MI), General Surgery (CG) and Traumatology (TyO).
• Patients receiving a diabetic diet orally
• Treated with diet alone, o any combination of oral anti-diabetic agents or insulin treatment with any dosage before admission.

Exclusion criteria

• Parenteral nutrition
• Hyperglycemia without a known history of diabetes
• Impaired renal function (glomerular filtration rate less than 30)
• Diabetic ketoacidosis and hyperosmolar state
• Type 1 Diabetes mellitus
• Pregnancy
• Patients on treatment with more than 10mg prednisone or steroid boluses.
• Known hypopituitarism or adrenal insufficiency
• Hyperglycaemia due to stress (negative antecedent of DM2, hyperglycemia and HbA1 <6.5)
• Severe liver disease (Child-Pugh C score)
• Acute pancreatitis
• Patients with sepsis or multiple organ failure
• Candidates for intensive care unit