INTRODUCTION: Despite the continuously growing number of therapeutic options for type 2 diabetes mellitus (T2DM) including insulins, a large percentage of patients fail to achieve HbA1c targets. Several real-world studies focused on patients with T2DM receiving insulin treatment in outpatient settings were conducted, but information about real-world in-hospital insulin management is lacking. The aim of this study was to describe the management of insulin therapy with a focus on basal-bolus and premixed insulin regimens in patients with T2DM under routine in-hospital medical practice in the Czech Republic. METHODS: This non-interventional prospective study was conducted from June 2014 to December 2017 in 22 centers in the Czech Republic under routine clinical practice conditions. Adult patients admitted to hospital with metabolically uncontrolled T2DM [HbA1c ≥ 60 mmol/mol; > 7.6% Diabetes Control and Complications Trial (DCCT)] and there treated with basal-bolus and premixed insulin regimens were documented during hospitalization. RESULTS: Overall, 369 patients with T2DM (54.7% male, mean age 64.44 ± 13.84 years, BMI 31.10 ± 6.00 kg/m2, duration of diabetes 8.11 ± 9.93 years, HbA1c 95.90 ± 24.38 mmol/mol, length of stay was 7.94 ± 4.53 days) were included. The percentage of glucose values under 10 mmol/l at time of randomization (the group with basal-bolus insulin regimen vs. the premix insulin regimen group) was 24.2% vs. 33.5% (p = 0.053), at time of first insulin dose adjustment it was 43.1% vs. 50.0% (p = 0.330), and 1 day before hospital discharge it was 61.7% vs. 61.4% (p = 0.107). A hypoglycemic event occurred in a total of 15 patients in the basal-bolus regimen group, and no hypoglycemic event occurred in the premixed insulin regimen group. CONCLUSION: In-hospital insulin management regarding basal-bolus and premixed insulin regimens is safe and in concordance with current international recommendations.

Department of Internal Medicine 2nd Faculty of Medicine Charles University 5 Úvalu 84 150 00 Prague Czech Republic

Department of Internal Medicine 3rd Faculty of Medicine and Faculty Hospital Královské Vinohrady Charles University Prague Czech Republic

Institute of Biostatistics and Analyses Ltd Brno Czech Republic

Private Department of Diabetology Internal Medicine and Metabolism Kosice Slovakia

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Selvin E, Parrinello ChM, Daya N, Bergenstal RM. Trends in insulin use and diabetes control in the U.S.: 1988–1994 and 1999–2012. Diabetes Care. 2016;39(3):e33–e35. doi: 10.2337/dc15-2229. PubMed DOI PMC

Pablos-Velasco P, Parhofer KG, Bradley C, et al. Current level of glycaemic control and its associated factors in patients with type 2 diabetes across Europe: data from the PANORAMA study. Clin Endocrinol. 2014;80:47–56. doi: 10.1111/cen.12119. PubMed DOI

Zdarska DJ, Hill M, Kvapil M, Pithova P, Broz J. Analysis of postprandial glycemia in relation to metabolic compensation and other observed parameters of outpatients with type 2 diabetes mellitus in the Czech Republic. Diabetes Ther. 2018;9:665–672. doi: 10.1007/s13300-018-0379-3. PubMed DOI PMC

Brož J, Janíčková Žďárská D, Urbanová J, et al. Current level of glycemic control and clinical inertia in subjects using insulin for the treatment of type 1 and type 2 diabetes in the Czech Republic and the Slovak Republic: results of a multinational, multicenter, observational survey (DIAINFORM) Diabetes Ther. 2018;9:1897. doi: 10.1007/s13300-018-0485-2. PubMed DOI PMC

Brož J, Janíčková Ždárská D, Urbanová J. Results of insulin therapy in type 2 diabetes mellitus patients in the Czech Republic: do they reflect the current status in other countries? Diabetes Ther. 2019;10(4):1181–1188. doi: 10.1007/s13300-019-0637-z. PubMed DOI PMC

Czech Pharmaceuticals Act No. 378/2007 Sb. https://www.sukl.eu/sukl/pursuant-to-act-no-378-2007-coll-on-pharmaceuticals-and-on. Accessed 23 Nov 2020.

American Diabetes Association Diabetes care in the hospital: standards of medical care in diabetes—2019. Diabetes Care. 2020;43(suppl 1):S193–S202. doi: 10.2337/dc20-S015. PubMed DOI

Bellido V, Suarez L, Rodriguez MG, et al. Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes. Diabetes Care. 2015;38:2211–2216. doi: 10.2337/dc15-0160. PubMed DOI PMC

Schiel R, Muller UA, Rauchfub J, Sprott H, Muller R. Blood-glucose self-monitoring in insulin treated type 2 diabetes mellitus a cross-sectional study with an intervention group. Diabetes Metab. 1999;25:334–340. PubMed

Eliasson B, Ekstrom N, Bruce Wirta S, et al. Metabolic effects of Basal or premixed insulin treatment in 5077 insulin-naïve type 2 diabetes patients: registry based observational study in clinical practice. Diabetes Ther. 2014;5:243–254. doi: 10.1007/s13300-014-0068-9. PubMed DOI PMC

Kalra S, Balhara YP, Sahay BK, et al. Why is premixed insulin the preferred insulin? Novel answers to a decade-old question. J Assoc Physicians India. 2013;61(Suppl):9–11. PubMed

Moghissi ES, Korytkowski MT, Di Nardo M, et al. American Association of Clinical Endocrinologists; American Diabetes Association. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32:1119–1131. doi: 10.2337/dc09-9029. PubMed DOI PMC