{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:15:58Z","timestamp":1785417358352,"version":"3.56.0"},"reference-count":42,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011946","name":"Abbott Diabetes Care","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100011946","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/03vb88585","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biosensors"],"abstract":"<jats:p>Background: Algorithm-based insulin dosing systems are increasingly used in hospitals and have shown the potential to efficiently and safely enable glycemic control. The goal of this study was to evaluate glycemic control using the ultralong-acting basal insulin degludec (IDeg) in combination with insulin aspart (IAsp) within an algorithm-driven electronic clinical decision support system (cDSS) in inpatients with type 2 diabetes (T2D). Methods: In this non-controlled single-arm pilot study, an electronic, algorithm-based cDSS was applied for the management of insulin treatment in an internal general ward. Thirty hospitalized patients with T2D (18 female, age 74.1 \u00b1 10.9 years, HbA1c 72.4 \u00b1 22.3 mmol\/mol, BMI 28.6 \u00b1 5.6 kg\/m2, diabetes duration 13.2 \u00b1 11.6 years, creatinine 1.5 \u00b1 1.2 mg\/dL, length of hospital stay 9.1 \u00b1 4.0 days) were included in the study. Capillary blood glucose (BG) was evaluated four times daily using a point-of-care device integrated into the hospital information system. In addition, all participants received a blinded continuous glucose monitoring (CGM; Abbott Freestyle Libre Pro) system. The primary endpoint was defined as the percentage of BG measurements within the target range of 3.9\u20137.8 mmol\/L. Results: Overall, 722 BG values and 17,242 CGM data points were available. Of those, 52.2% and 55.0% were in the specified target area (3.9\u20137.8 mmol\/L), respectively. Mean BG prior to study start was 11.9 \u00b1 4.4 mmol\/L and improved to 7.5 \u00b1 1.9 mmol\/L and 7.4 \u00b1 1.4 mmol\/L after 6 and 10 days of treatment. BG &lt; 3.9, &lt;3.0 and &lt;2.2 mmol\/L was 1.25%, 0.28% and 0%, respectively. Adherence to the total daily insulin dose suggested by the cDSS was 94.2%, and 99.5% of all basal and 85.3% of all bolus insulin suggestions were accepted by the nurses in charge. Basal-bolus therapy using the cDSS covered 85% of the participants\u2019 total hospital stay. Conclusions: Glycemic control using IDeg within an algorithm-driven cDSS could effectively and safely be achieved in the hospital and was highly accepted.<\/jats:p>","DOI":"10.3390\/bios16050289","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T10:25:16Z","timestamp":1779099916000},"page":"289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Glycemic Efficacy and Safety by Using Insulin Degludec and Aspart Guided by a Clinical Decision Support System in Non-Critically Ill Inpatients with Type 2 Diabetes Mellitus"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9947-1413","authenticated-orcid":false,"given":"Felix","family":"Aberer","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4872-8861","authenticated-orcid":false,"given":"Daniel A.","family":"Hochfellner","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7665-0929","authenticated-orcid":false,"given":"Petra M.","family":"Baumann","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"H\u00f6ll","sequence":"additional","affiliation":[{"name":"Decide Clinical Software GmbH, 8020 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Beck","sequence":"additional","affiliation":[{"name":"Decide Clinical Software GmbH, 8020 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3554-0405","authenticated-orcid":false,"given":"Thomas R.","family":"Pieber","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria"},{"name":"Decide Clinical Software GmbH, 8020 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-4233","authenticated-orcid":false,"given":"Julia K.","family":"Mader","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.4158\/EP161414.OR","article-title":"Impact of Glucose Management Team on Outcomes of Hospitalizaron in Patients with Type 2 Diabetes Admitted to the Medical Service","volume":"22","author":"Wang","year":"2016","journal-title":"Endocr. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1097\/SLA.0000000000002323","article-title":"Effect of Preoperative Diabetes Management on Glycemic Control and Clinical Outcomes After Elective Surgery","volume":"267","author":"Garg","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.jdiacomp.2012.11.010","article-title":"Impact of diabetes on inpatient mortality and length of stay for elderly patients presenting with fracture of the proximal femur","volume":"27","author":"Nirantharakumar","year":"2013","journal-title":"J. Diabetes Complicat."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.2337\/dc08-2127","article-title":"Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward","volume":"32","author":"Turchin","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2021). 15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2021. Diabetes Care, 44, S211\u2013S220.","DOI":"10.2337\/dc21-S015"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/S2213-8587(20)30381-8","article-title":"Management of diabetes and hyperglycaemia in the hospital","volume":"9","author":"Pasquel","year":"2021","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"548","DOI":"10.4338\/ACI-2014-04-RA-0033","article-title":"A toolbox to improve algorithms for insulin-dosing decision support","volume":"5","author":"Donsa","year":"2014","journal-title":"Appl. Clin. Inform."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1111\/dom.12186","article-title":"Efficacy, usability and sequence of operations of a workflow-integrated algorithm for basal-bolus insulin therapy in hospitalized type 2 diabetes patients","volume":"16","author":"Mader","year":"2014","journal-title":"Diabetes Obes. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1089\/dia.2015.0027","article-title":"Standardized Glycemic Management with a Computerized Workflow and Decision Support System for Hospitalized Patients with Type 2 Diabetes on Different Wards","volume":"17","author":"Neubauer","year":"2015","journal-title":"Diabetes Technol. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/1932296816676501","article-title":"A Mobile Computerized Decision Support System to Prevent Hypoglycemia in Hospitalized Patients with Type 2 Diabetes Mellitus","volume":"11","author":"Spat","year":"2017","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1111\/dom.13559","article-title":"GlucoTab-guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes","volume":"21","author":"Aberer","year":"2019","journal-title":"Diabetes Obes. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1177\/1932296820955243","article-title":"Safe and Sufficient Glycemic Control by Using a Digital Clinical Decision Support System for Patients with Type 2 Diabetes in a Routine Setting on General Hospital Wards","volume":"15","author":"Lichtenegger","year":"2021","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s13300-014-0076-9","article-title":"Insulin degludec versus insulin glargine in type 1 and type 2 diabetes mellitus: A meta-analysis of endpoints in phase 3a trials","volume":"5","author":"Vora","year":"2014","journal-title":"Diabetes Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1210\/jcem-21-11-1440","article-title":"Clinical assessment of body hair growth in women","volume":"21","author":"Ferriman","year":"1961","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"8726046","DOI":"10.1155\/2018\/8726046","article-title":"Efficacy and Safety of Insulin Degludec versus Insulin Glargine: A Systematic Review and Meta-Analysis of Fifteen Clinical Trials","volume":"2018","author":"Liu","year":"2018","journal-title":"Int. J. Endocrinol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1111\/dom.13708","article-title":"Lower rates of hypoglycaemia in older individuals with type 2 diabetes using insulin degludec versus insulin glargine U100: Results from SWITCH 2","volume":"21","author":"Heller","year":"2019","journal-title":"Diabetes Obes. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1111\/dom.13149","article-title":"A European, multicentre, retrospective, non-interventional study (EU-TREAT) of the effectiveness of insulin degludec after switching basal insulin in a population with type 1 or type 2 diabetes","volume":"20","author":"Siegmund","year":"2018","journal-title":"Diabetes Obes. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/dme.13976","article-title":"Clinical benefits of switching to insulin degludec irrespective of previous basal insulin therapy in people with Type 1 or Type 2 diabetes: Evidence from a European, multicentre, retrospective, non-interventional study (EU-TREAT)","volume":"36","author":"Knudsen","year":"2019","journal-title":"Diabet. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1177\/2042018812437181","article-title":"Efficacy and safety of ultra-long-acting insulin degludec","volume":"3","author":"Wakil","year":"2012","journal-title":"Ther. Adv. Endocrinol. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2018). 14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2018. Diabetes Care, 41, S144\u2013S151.","DOI":"10.2337\/dc18-S014"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1177\/193229681300700234","article-title":"Recommendations for standardizing glucose reporting and analysis to optimize clinical decision making in diabetes: The ambulatory glucose profile","volume":"7","author":"Bergenstal","year":"2013","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.2337\/dc12-1988","article-title":"Randomized study comparing a Basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: Basal plus trial","volume":"36","author":"Umpierrez","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/dom.14544","article-title":"Degludec hospital trial: A randomized controlled trial comparing insulin degludec U100 and glargine U100 for the inpatient management of patients with type 2 diabetes","volume":"24","author":"Galindo","year":"2022","journal-title":"Diabetes Obes. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1210\/jc.2011-2098","article-title":"Management of hyperglycemia in hospitalized patients in non-critical care setting: An endocrine society clinical practice guideline","volume":"97","author":"Umpierrez","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1056\/NEJMoa1204942","article-title":"Hypoglycemia and risk of death in critically ill patients","volume":"367","author":"Investigators","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00134-016-4523-0","article-title":"Glycemic control, mortality, and hypoglycemia in critically ill patients: A systematic review and network meta-analysis of randomized controlled trials","volume":"43","author":"Yamada","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.eprac.2024.12.014","article-title":"Insulin Degludec in Critically Ill Patients with Type 2 Diabetes Mellitus: A Prospective Interventional Study","volume":"31","author":"Hakeam","year":"2025","journal-title":"Endocr. Pract."},{"key":"ref_28","unstructured":"Feingold, K.R., Anawalt, B., Boyce, A., Chrousos, G., Dungan, K., Grossman, A., Hershman, J.M., Kaltsas, G., Koch, C., and Kopp, P. (2000). Management of Diabetes and Hyperglycemia in Hospitalized Patients, Endotext."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1177\/1932296815602905","article-title":"Continuous Glucose Monitoring Versus Capillary Point-of-Care Testing for Inpatient Glycemic Control in Type 2 Diabetes Patients Hospitalized in the General Ward and Treated With a Basal Bolus Insulin Regimen","volume":"10","author":"Gomez","year":"2015","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Schrangl, P., Reiterer, F., Heinemann, L., Freckmann, G., and Del Re, L. (2018). Limits to the Evaluation of the Accuracy of Continuous Glucose Monitoring Systems by Clinical Trials. Biosensors, 8.","DOI":"10.3390\/bios8020050"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2730","DOI":"10.2337\/dc19-2073","article-title":"Comparison of the FreeStyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing in Hospitalized Patients with Type 2 Diabetes Treated with Basal-Bolus Insulin Regimen","volume":"43","author":"Galindo","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s13300-017-0271-6","article-title":"Efficacy and Safety of Insulin Degludec for Hyperglycemia Management in Noncritical Hospitalized Patients with Diabetes: An Observational Study","volume":"8","author":"Simioni","year":"2017","journal-title":"Diabetes Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1007\/s13300-024-01533-6","article-title":"Insulin Degludec in People with Type 2 Diabetes in China: A Non-interventional, Retrospective Chart Review Study (CN-TREAT)","volume":"15","author":"Wang","year":"2024","journal-title":"Diabetes Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.1007\/s13300-020-00915-w","article-title":"Understanding the Clinical Profile of Insulin Degludec, the Latest Basal Insulin Approved for Use in Canada: A Narrative Review","volume":"11","author":"Woo","year":"2020","journal-title":"Diabetes Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1177\/193229681300700217","article-title":"Failure to control hyperglycemia in noncritically ill diabetes patients despite standard glycemic management in a hospital setting","volume":"7","author":"Neubauer","year":"2013","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s00125-017-4423-z","article-title":"Day-to-day fasting glycaemic variability in DEVOTE: Associations with severe hypoglycaemia and cardiovascular outcomes (DEVOTE 2)","volume":"61","author":"Zinman","year":"2018","journal-title":"Diabetologia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1475-2840-12-33","article-title":"Prognostic value of early in-hospital glycemic excursion in elderly patients with acute myocardial infarction","volume":"12","author":"Su","year":"2013","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"632","DOI":"10.4103\/ijem.IJEM_11_18","article-title":"Effect of Glycemic Variability on Mortality in ICU Settings: A Prospective Observational Study","volume":"22","author":"Singh","year":"2018","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_39","first-page":"8","article-title":"Reduction of glycemic variability with Degludec insulin in patients with unstable diabetes","volume":"12","author":"Munoz","year":"2018","journal-title":"J. Clin. Transl. Endocrinol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1111\/dom.14161","article-title":"Effects of insulin degludec and insulin glargine U300 on glycaemic stability in individuals with type 1 diabetes: A multicentre, randomized controlled crossover study","volume":"22","author":"Miura","year":"2020","journal-title":"Diabetes Obes. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Alhmoud, E.N., Saad, M.O., and Omar, N.E. (2023). Efficacy and safety of insulin glargine 300 units\/mL vs insulin degludec in patients with type 1 and type 2 diabetes: A systematic review and meta-analysis. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1285147"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1089\/dia.2014.0343","article-title":"Taking a Closer Look--Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Type 2 Diabetes Mellitus Under Basal-Bolus Insulin Therapy","volume":"17","author":"Schaupp","year":"2015","journal-title":"Diabetes Technol. Ther."}],"container-title":["Biosensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6374\/16\/5\/289\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:24:46Z","timestamp":1779164686000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6374\/16\/5\/289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,16]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["bios16050289"],"URL":"https:\/\/doi.org\/10.3390\/bios16050289","relation":{},"ISSN":["2079-6374"],"issn-type":[{"value":"2079-6374","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,16]]}}}