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 convencional: revisión sistemática de la literatura y metaanálisis / Effective adverse event reduction with bolus-basal versus sliding scale insulin therapy in patients with diabetes during conventional hospitalization: Systematic review and meta-analysis

Introducción: El objetivo de esta revisión es evaluar la efectividad para disminuir los eventos adversos clínicos y la seguridad de la insulinoterapia en régimen bolo-basal-corrector o basal-corrector frente a la insulinoterapia en «pauta deslizante», en pacientes con diabetes o con hiperglucemia de reciente diagnóstico ingresados en una planta de hospitalización convencional, no críticos, tanto médica como quirúrgica. Método: Se realizó búsqueda en Medline. La odds ratio fue la medida resumen principal. Se empleó un modelo de efectos aleatorios con la técnica de Mante-Haenszel. Resultados: Novecientas cincuenta y siete citas de las cuales 9 fueron finalmente incluidas en la revisión sistemática. Los pacientes en el grupo BB tuvieron un mejor control glucémico que aquellos con PD. Globalmente, se objetiva una tendencia no significativa hacia un menor riesgo de eventos adversos en el grupo BB frente a PD (OR 0,67 —IC 95%: 0,22-2,04— [I2 = 71%]). Existe una tendencia no significativa hacia un mayor riesgo de hipoglucemia en el grupo BB (OR: 2,29; IC 95% 0,50-10,49 [I2 = 70%]). Conclusión: A pesar de su beneficio para el control glucémico durante la hospitalización, esta revisión no ha objetivado que el uso de la pauta BB disminuya eventos clínicos en pacientes hospitalizados en planta convencional. Debido a la heterogeneidad en los resultados, consideramos que se requieren ensayos clínicos que contemplen su efecto en subgrupos de pacientes en los que la pauta BB se pueda usar de forma segura y con períodos de seguimiento más prolongados (AU)

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 (AU)

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

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.