Diabetes Management in Hospitalized Patients with Type 2 Diabetes (T2D) during Fasting Periods

To date little data exists on diabetes management during fasting periods on the general ward. The aim of the analysis was to assess standardized diabetes management using GlucoTab^® - a digital algorithm driven basal-bolus insulin therapy - in hospitalized patients with T2D in the fasting period. Data from two clinical trials were pooled. Patients were included in the analysis if they had at least one fasting period during hospital stay at the general ward. Periods of fasting were compared with periods of regular food intake. Out of 191 T2D patients 91 (48%, 5 on surgical and 86 patients on internal medicine wards, 32 female, age 68 ± 12 years, HbA1c 67 ± 19 mmol/mol, BMI 30 ± 15 kg/m², diabetes duration 15 ± 11 years, creatinine 1.8 ± 1.4 mg/dl, length of hospital stay 10 ± 6 days) were included comprising overall 131 fasting periods. Mean blood glucose was lower during fasting periods as compared to periods with regular food intake (153 ± 38 vs. 158 ± 24 mg/dl, p = 0.033). Hypoglycemia (<70 mg/dl) was documented in 1.35% (fasting) vs. 1.91% (non-fasting) of all measurements, respectively. In neither period BG <40 mg/dl occurred.Insulin doses during fasting vs. non-fasting were as follows: bolus insulin 18.0 ± 12.7 vs. 26.0 ± 17.1 U; basal insulin 20.7 ± 13.2 vs. 22.3 ± 15.2 U. Fasting is common among patients on a general ward. Our data demonstrate that standardized diabetes management by GlucoTab^® using a basal-bolus insulin algorithm is safe and effective in fasting state.