Endocrine Abstracts (2017) 49 EP609 | DOI: 10.1530/endoabs.49.EP609

Increase in time in target when using a basal-bolus algorithm for insulin dosing with insulin glargine U300 during hospital stay

Julia K Mader1, Klaus Donsa2, Felix Aberer1, Katharina Lichtenegger1, Christian Lanz1, Edin Smajic1, Bernhard Höll2, Peter Beck3, Thomas R Pieber1,2 & Johannes Plank

1Medical University of Graz, Graz, Austria; 2Joanneum Research GmbH, Graz, Austria; 3Decide Clinical Software GmbH, Graz, Austria.

Background and aims: Insulin therapy and the use of clinical decision support systems to achieve glycaemic control in hospitalized patients with hyperglycaemia are recommended by clinical guidelines. The aim of this evaluation was to assess time in target by continuous glucose monitoring (CGM) achieved by a basal-bolus insulin algorithm using insulin glargine U300 during hospital stay in patients with type 2 diabetes (T2D).

Material and methods: 30 patients with T2D (12 female, age 67±11 years, HbA1c 79±2 6 mmol/mol, BMI 32±6 kg/m2, diabetes duration 14±11 years) were treated with GlucoTab, a mobile system providing automated workflow support and suggestions for insulin dosing to health care professionals, during hospital stay. Insulins glargine U300 and glulisine were used for basal-bolus therapy. Additionally to blood glucose measurements, blinded CGM (iPro2, Medtronic) was performed throughout the study.

Results: Mean total daily insulin dose was 63.8±39.8 U. A total of 49,846 CGM values were collected. Mean daily sensor glucose was 8.4±1.2 mmol/l. Percentage of CGM values in the ranges was as follows: 5.6–7.8 mmol/l (42.0%), 3.9–10 mmol/l (80.2%), >10 mmol/l (19.0%), >16.7 mmol/l (1.5%). Percentage in the hypoglycaemic range were low: <3.9 mmol/l (0.77%), <3.3 mmol/l (0.35%) and <2.8 mmol/l (0.15%), respectively. When comparing the first vs last full 24-h period, time in target 3.9–10 mmol/l (61.8% vs 85.2%) increased, whereas time in hyperglycaemia >10 mmol/l (37.1% vs 14.2%) and hypoglycaemia <3.9 mmol/l (1.2% vs 0.6%) decreased.

Conclusions: Basal-bolus insulin therapy using insulin glargine U300 safely establishes glycaemic control as assessed by CGM. Over time percentage of values in target increases without increasing the risk of hypoglycaemia.