Basal-Bolus Versus Sliding-Scale Insulin Therapy in the Acute Care Hospital Setting: A Review of Comparative Clinical Effectiveness and Cost-Effectiveness

Question

1. What is the comparative clinical effectiveness of basal-bolus versus sliding-scale insulin therapy for adult patients with type 1 and type 2 diabetes in the acute care hospital setting?
2. What is the cost-effectiveness of basal-bolus versus sliding-scale insulin therapy for adult patients with type 1 and type 2 diabetes in the acute care hospital setting?

Key Message

One systematic review and three primary studies on comparative clinical effectiveness in patients with type 1 or type 2 diabetes or newly-diagnosed or recurrent hyperglycemia were found. Patients receiving basal-bolus or basal-corrective insulin therapy had lower blood glucose levels and a lower risk of hyperglycemia than those receiving sliding-scale insulin therapy. No significant differences were found in the risk of adverse events between the two interventions. Results on lengths of hospitalization and the risk of hypoglycemia were mixed across the studies. No economic evaluations fulfilling the selection criteria were found.