An Integrative Literature Review of Basal-Bolus Insulin versus Sliding-Scale Insulin for Glycemic Management in the Hospitalized Non-Critically Ill Type 2 Diabetic Patient



Diabetes is an increasingly common chronic disease that affects the body’s normal ability to control blood glucose levels due to impaired use of the hormone insulin. It is estimated that one out of every 4 adults who are hospitalized also have a diagnosis of diabetes. Diabetic inpatients face unique challenges in regards to managing their blood glucose while hospitalized due to the physiological stress of acute illness. Unfortunately, those who experience inadequate blood glucose management in the hospital are at an increased risk for poor patient outcomes, such as infection, increased length of stay, and death. There are multiple medications used to regulate blood sugar levels; however, the most commonly prescribed treatment for inpatients is the traditional sliding-scale regimen followed by the basal-bolus insulin regimen. An integrated literature review was conducted to determine if basal-bolus insulin is more effective than sliding-scale insulin in managing blood glucose levels of non-critically ill diabetic inpatients. Four well-known databases were searched and 5 relevant quantitative research articles were obtained and analyzed. The majority of the evidence supports basal-bolus insulin as the most effective treatment for managing blood glucose and preventing hyperglycemia without increasing the risk for hypoglycemia. Health care providers should order basal-bolus insulin accordingly in order to improve patient outcomes. Future research that questions why sliding-scale insulin is still widely prescribed may identify barriers related to ordering basal-bolus insulin and assist in decreasing related adverse events.


Basal-bolus insulin, blood glucose, diabetes, glycemic control, inpatient, sliding-scale insulin

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Centers for Disease Control and Prevention. Available at: resources/publications/aag/diabetes.htm, accessed March 2017.

AR Gosmanov. A practical and evidence-based approach to management of inpatient diabetes in non-critically ill patients and special clinical populations. J. Clin. Transl. Endocrinol. 2016; 5, 1-6.

V Magaji and JM Johnston. Inpatient management of hyperglycemia and diabetes. Clin. Diabetes 2011; 29, 3-9.

JG Timmons, SG Cunningham, CA Sainsbury and GC Jones. Inpatient glycemic variability and long-term mortality in hospitalized patients with type 2 diabetes. J. Diabetes Complications 2017; 31, 479-82.

JA Johnston and ERV Horn. The effects of correction insulin and basal insulin on inpatient glycemic control. Medsurg. Nurs. 2011; 20, 187-93.

BM Melnyk and E Fineout-Overholt. Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. 3rd eds. Lippincott Williams & Wilkins, Philadelphia, 2015, p. 91-2.

HL Rymaszewski and S Breakwell. A retrospective review of sliding scale vs. basal/bolus insulin protocols. J. Nurs. Pract. 2013; 9, 214-8.

GE Umpierrez, D Smiley, A Zisman, LM Prieto, A Palacio, M Ceron and R Mejia. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care 2007; 30, 2181-6.

G Umpierrez, D Smiley, S Jacobs, L Peng, A Temponi, P Mulligan and M Rizzo. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care 2011; 34, 256-61.

HH Zaman, V Permalu and SR Vethakkan. Sliding-scale versus basal-bolus insulin in the management of severe or acute hyperglycemia in type 2 diabetes patients: A retrospective study. Plos One 2014; 2014, e106505.

S Clement, SS Braithwaite, MF Magee, A Ahmann, EP Smith, RG Schafer and IB Hirsh. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004; 27, 553-591.

MB Christensen, A Gotfredsen and K Norgaard. Efficacy of basal-bolus insulin regimens in the inpatient management of non-critically ill patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab. Res. Rev. 2017; 33, e2885.

YY Lee, YM Lin, WJ Leu, MY Wu, JH Tseng, MT Hsu, CS Tsai, AT Hsieh and K Tam. Sliding-scale insulin used for blood glucose control: A meta-analysis of randomized controlled trials. Metab. Clin. Exp. 2015; 64, 1183-92.

The Joint Commission. Available at: inpatient_diabetes.aspx, accessed March 2017.

American Diabetes Association. Diabetes care in the hospital. Diabetes Care 2016; 39, 99-104.


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Last updated: 12 August 2019