***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Effective and easily implemented insulin regimens are needed to facilitate hospital glycemic control in general medical and surgical patients with type 2 diabetes ( T2D ) . RESEARCH DESIGN AND METHODS This multicenter trial r and omized 375 patients with T2D treated with diet , oral antidiabetic agents , or low-dose insulin ( ≤0.4 units/kg/day ) to receive a basal-bolus regimen with glargine once daily and glulisine before meals , a basal plus regimen with glargine once daily and supplemental doses of glulisine , and sliding scale regular insulin ( SSI ) . RESULTS Improvement in mean daily blood glucose ( BG ) after the first day of therapy was similar between basal-bolus and basal plus groups ( P = 0.16 ) , and both regimens result ed in a lower mean daily BG than did SSI ( P = 0.04 ) . In addition , treatment with basal-bolus and basal plus regimens result ed in less treatment failure ( defined as > 2 consecutive BG > 240 mg/dL or a mean daily BG > 240 mg/dL ) than did treatment with SSI ( 0 vs. 2 vs. 19 % , respectively ; P < 0.001 ) . A BG < 70 mg/dL occurred in 16 % of patients in the basal-bolus group , 13 % in the basal plus group , and 3 % in the SSI group ( P = 0.02 ) . There was no difference among the groups in the frequency of severe hypoglycemia ( < 40 mg/dL ; P = 0.76 ) . CONCLUSIONS The use of a basal plus regimen with glargine once daily plus corrective doses with glulisine insulin before meals result ed in glycemic control similar to a st and ard basal-bolus regimen . The basal plus approach is an effective alternative to the use of a basal-bolus regimen in general medical and surgical patients with T2D OBJECTIVE The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial . RESEARCH DESIGN AND METHODS We r and omized patients with diabetes ( n = 152 ) and without diabetes ( n = 150 ) with hyperglycemia to an intensive glucose target of 100–140 mg/dL ( n = 151 ) or to a conservative target of 141–180 mg/dL ( n = 151 ) after coronary artery bypass surgery ( CABG ) surgery .  After the intensive care unit ( ICU ) , patients received a single treatment regimen in the hospital and 90 days postdischarge . Primary outcome was differences in a composite of complications , including mortality , wound infection , pneumonia , bacteremia , respiratory failure , acute kidney injury , and major cardiovascular events . RESULTS Mean glucose in the ICU was 132 ± 14 mg/dL ( interquartile range [ IQR ] 124–139 ) in the intensive and 154 ± 17 mg/dL ( IQR 142–164 ) in the conservative group ( P < 0.001 ) . There were no significant differences in the composite of complications between intensive and conservative groups ( 42 vs. 52 % , P = 0.08 ) . We observed heterogeneity in treatment effect according to diabetes status , with no differences in complications among patients with diabetes treated with intensive or conservative regimens ( 49 vs. 48 % , P = 0.87 ) , but a significant lower rate of complications in patients without diabetes treated with intensive compared with conservative treatment regimen ( 34 vs. 55 % , P = 0.008 ) . CONCLUSIONS Intensive insulin therapy to target glucose of 100 and 140 mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180 mg/dL after CABG surgery . Subgroup analysis showed a lower number of complications in patients without diabetes , but not in patients with diabetes treated with the intensive regimen . Large prospect i ve r and omized studies are needed to confirm these findings Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients ; however , it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome . The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes . We review ed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center , a community teaching hospital in downtown Atlanta , GA , from July 1 , 1998 , to October 20 , 1998 . New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl ( 7 mmol/liter ) or more or a r and om blood glucose level of 200 mg/dl ( 11.1 mmol/liter ) or more on 2 or more determinations . Hyperglycemia was present in 38 % of patients admitted to the hospital , of whom 26 % had a known history of diabetes , and 12 % had no history of diabetes before the admission . Newly discovered hyperglycemia was associated with higher in-hospital mortality rate ( 16 % ) compared with those patients with a prior history of diabetes ( 3 % ) and subjects with normoglycemia ( 1.7 % ; both P < 0.01 ) . In addition , new hyperglycemic patients had a longer length of hospital stay , a higher admission rate to an intensive care unit , and were less likely to be discharged to home , frequently requiring transfer to a transitional care unit or nursing home facility . Our results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes . Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia OBJECTIVE To determine if the improvement in inpatient glycaemic control observed with basal-bolus insulin ( BBI ) over sliding-scale insulin ( SSI ) in the formal study setting translates to routine clinical conditions . DESIGN , SETTING AND PATIENTS Cross-sectional study in which capillary blood glucose levels ( BGLs ) were prospect ively measured four times daily for up to 8 days in 124 patients with type 2 diabetes admitted to a tertiary teaching hospital and treated with BBI between November 2008 and May 2010 . Data from the BBI treatment group were compared with retrospective data from 96 patients treated with SSI  between June 2001 and May 2006 . MAIN OUTCOME MEASURES Mean daily BGL ; independent effect of insulin regimen on mean daily BGL . RESULTS Mean baseline BGL was not significantly different in patients receiving BBI and SSI ( mean ± SD , 11.3 ± 4.1 v 10.6 ± 4.3 mmol/L ; P = 0.23 ) . After the first full day of therapy , mean daily BGL for patients receiving BBI was 1.6 ± 3.7 mmol/L lower than baseline BGL , and it remained 1.6 - 2.4 mmol/L lower than baseline throughout the study ( P < 0.001 ) . In contrast , there was no significant change in BGL for patients receiving SSI . R and om effects regression analysis indicated that BBI was associated with a significantly lower mean daily BGL  than SSI , independent of other variables ( P < 0.001 ) . The incidence of hypoglycaemia ( BGL < 4 mmol/L ) was significantly greater in patients receiving BBI than SSI ( 3.3 % v 1.4 % ; P < 0.001 ) , but there was no significant difference for severe hypoglycaemia ( BGL < 2.8 mmol/L ) ( 0.3 v 0.5 % ; P = 0.3 ) . CONCLUSIONS Under routine clinical conditions , BBI  is effective and safe across a range of patients and appears to be superior to SSI . Clinical improvements reflected those seen in a strict formal study setting AIMS Guidelines recommend use of basal-bolus insulin in hospitalised patients with hyperglycaemia , but information about implementation and medication reconciliation at discharge is scarce . The HOSMIDIA study evaluated a management program involving basal-bolus insulin and an algorithm for medication reconciliation at discharge in non-critically ill hospitalised patients with type 2 diabetes in clinical practice . METHODS HOSMIDIA was a prospect i ve , observational study performed during routine clinical practice at 15 Spanish hospitals during hospitalisation , with follow-up 3 months postdischarge . Study patients ( n = 134 ) received a basal-bolus regimen with insulin glargine during hospitalisation and treatment at discharge was adjusted according to a simple algorithm .  The control group ( n = 62 ) included patients with similar characteristics hospitalised during the month before study initiation and had no follow-up after discharge . RESULTS Compared with control subjects , patients in the prospect i ve study achieved lower mean total ( 167.7 ± 41.1 vs. 190.5 ± 53.3 mg/dl ) prepr and ial ( 164.2 ± 42.4 vs. 189.6 ± 52.6 mg/dl ; p < 0.001 ) and fasting ( 137.0 ± 42.2 vs. 165.8 ± 56.5 mg/dl ) blood glucose levels while hospitalised , without increased hypoglycaemic episodes ( 17.7 % vs. 19.3 % patients ) . In the prospect i ve study , glycaemic control improved from admission to discharge , with control maintained 3 months after discharge . The main treatment modification at discharge compared with admission was addition of basal insulin , and treatment at discharge was maintained at 3 months in 89 % of patients . CONCLUSION The HOSMIDIA study confirmed that management of hyperglycaemia with basal-bolus insulin is feasible and effective in routine clinical practice , and that a simple strategy facilitating the reconciliation of medication on discharge can improve glycaemic control postdischarge BACKGROUND Hyperglycaemia and diabetes mellitus are common in patients hospitalized in the orthopaedic surgery ward . However , glycaemic control obtained during hospitalization is often suboptimal . No method for achieving adequate glycaemic control in this population has been vali date d in an in-hospital setting . INTERVENTION An intervention including an intensive subcutaneous insulin protocol in the orthopaedic department . METHODS All diabetic patients admitted to the Department of Orthopaedic Surgery were prospect ively r and omized during a 6-month period . One group ( n = 30 ) received st and ard care with sliding scale insulin and the other group ( n = 35 ) received the intervention protocol . During the intervention period , the staff was briefed on the importance of glucose monitoring and control . An intensive multiple-injection protocol consisting of four daily regular/neutral protamine hagedorn ( NPH ) insulin injections was initiated in diabetic patients . The programme was followed up by a consulting diabetologist . RESULTS Mean blood glucose levels throughout the hospitalization were 161.48 ± 3.8 mg/dL in the intervention group versus 175.29 ± 2.3 mg/dL in the control group ( p < 0.0005 ) . Hospitalization was shorter by 2 days in the intervention group ( p < 0.05 ) . The number of severe hyperglycaemic events ( blood glucose level above 400 mg% ) was significantly lower ( p < 0.05 ) in the intervention group . There was no significant difference in the number of hypoglycaemic events . CONCLUSIONS The suggested four-step intervention regimen improved glycaemic control of hospitalized patients in the orthopaedic department and simplified the ' in-house ' treatment of the diabetic patient . Hospital stays were reduced on average by two days ( p < 0.05 ) AIMS To evaluate glycaemic control and usability of a workflow-integrated algorithm for basal-bolus insulin therapy in a proof-of-concept study to develop a decision support system in hospitalized patients with type 2 diabetes . METHODS In this ward-controlled study , 74 type 2 diabetes patients ( 24 female , age 68 ± 11 years , HbA1c 8.7 ± 2.4 % and body mass index 30 ± 7 ) were assigned to either algorithm-based treatment with a basal-bolus insulin therapy or to st and ard glycaemic management . Algorithm performance was assessed by continuous glucose monitoring and staff 's adherence to algorithm-calculated insulin dose . RESULTS Average blood glucose levels ( mmol/l ) in the algorithm group were significantly reduced from 11.3 ± 3.6 ( baseline ) to 8.2 ± 1.8 ( last 24 h ) over a period of 7.5 ± 4.6 days ( p < 0.001 ) . The algorithm group had a significantly higher percentage of glucose levels in the ranges from 5.6 to 7.8 mmol/l ( target range ) and 3.9 to 10.0 mmol/l compared with the st and 
    Output:
    
In conclusion , basal-bolus insulin in the inpatient diabetes management results in significantly lower mean daily BG  than sliding scale insulin but is associated with increased risk of mild hypoglycemia