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J Am Med Dir Assoc. 2016 Mar 1;17(3):206-13. doi: 10.1016/j.jamda.2015.08.015. Epub 2015 Oct 1.

Sliding Scale Insulin vs Basal-Bolus Insulin Therapy in Long-Term Care: A 21-Day Randomized Controlled Trial Comparing Efficacy, Safety and Feasibility.

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Montefiore Medical Center (Wakefield Campus), Bronx, NY. Electronic address:
Lakeview Nursing and Rehabilitation Center, Chicago, IL; Carlton at the Lake, Chicago, IL; Cedar Pointe Rehab and Nursing, Cicero, IL; Presence Villa Scalabrini Nursing and Rehabilitation Center, Northlake, IL.
Life Care Nursing Home, Michigan City, IN.
Beaumont Rehabilitation and Skilled Nursing Center at Worcester, Worcester, MA.
Beth Abraham Health Services, Bronx, NY.
Bethany Village, Dayton, OH; Trinity Community Nursing Home, Beavercreek, OH.
Nebraska Skilled Nursing and Rehabilitation Center, Omaha, NE.
Koester Pavilion, Troy, OH.
St. John's Care Center, Sunrise, FL.
Heritage Healthcare of Macon, Macon, GA.
American Medical Directors Association Foundation, Columbia, MD.
Montefiore Medical Center (Wakefield Campus), Bronx, NY.



Sliding scale insulin (SSI) therapy remains a common means of insulin therapy in long-term care (LTC) for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Lack of randomized trial data on the efficacy and safety of basal-bolus insulin (B-BI) therapy in nursing home residents may have precluded this form of insulin administration in the LTC setting. Our study is a comparison of the efficacy of SSI (control) and B-BI (intervention) therapies during a 21-day intervention trial in older nursing home residents.


Fourteen LTC facilities in the US participated; 110 residents with type 2 diabetes volunteered to participate; 35 failed inclusion criteria, 75 signed informed written consent, and 11 were discharged to home/hospital or withdrew consent; data from 64 participants are reported. Recent fasting blood glucose (FBG), hemoglobin A1c, and chemistries were obtained. Four glucose readings (prior to breakfast, lunch, dinner, and bedtime), oral antiglycemic drug, and insulin doses and changes, and all adverse events/serious adverse events, both those related to glucose control [hypoglycemic (<70 mg/dL) and hyperglycemic (>200 mg/dL) episodes] and those unrelated, were recorded daily. Patients were randomized to either remain on SSI or be shifted to the B-BI group.


Nursing home residents 80 ± 8 (standard deviation) years, 66% female participated; Control and Intervention participants had similar age, gender, race distributions, comorbidity, and 3-day average pretrial FBG levels (all P > .05). At study end, B-BI volunteers had significantly lower 3-day average FBG levels vs pretrial (P = .0231) while SSI participants had no change in 3-day average FBG (P > .05). During the trial, participants from both groups had similar rates of hypoglycemia, hyperglycemia, other adverse events, and hospitalizations (serious adverse events) unrelated to glucose control (all P > .05).


B-BI therapy produced significantly lower average FBG levels after 21 days compared with SSI therapy; both groups had similar rates of hypo- and hyperglycemia. Switching to B-BI therapy is feasible, safe, and effective in the LTC setting.


Insulin therapy for type 2 diabetes in long term care; basal-bolus insulin therapy; efficacy and safety of basal-bolus insulin therapy in long-term care; sliding scale insulin therapy

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