Eficacia en la reducción de eventos adversos de la insulinoterapia en pauta bolo-basal frente a la pauta deslizante en pacientes con diabetes durante la hospitalización convencionalrevisión sistemática de la literatura y metaanálisis
- Covadonga Gómez Cuervo 1
- Ana Sánchez Morla 2
- María Asunción Pérez-Jacoiste Asín 1
- Otilia Bisbal Pardo 1
- Luis Pérez Ordoño 2
- Juan Vila Santos 2
- 1 Hospital Universitario 12 de Octubre. Servicio de Medicina Interna
- 2 Hospital Universitario 12 de Octubre. Servicio de Urgencias
ISSN: 1575-0922
Year of publication: 2016
Volume: 63
Issue: 4
Pages: 145-156
Type: Article
More publications in: Endocrinología y nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Abstract
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], [I2 = 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] [I2 = 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.