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Effectiveness of basal bolus insulin (BBI) administration versus other insulin regimen administration methods for hospitalized adult, non-critical care patients with hyperglycemia: a systematic review protocol

Roderman, Nicki MSN, RN, CCRN, CNRN; Haire, Sandy MS, BSN, RN, NEA-BC, FACHE; Hawley, Diane PhD, RN, ACNS-BC, CCNS, CNE

Author Information
JBI Database of Systematic Reviews and Implementation Reports: March 2014 - Volume 12 - Issue 3 - p 121-132
doi: 10.11124/jbisrir-2014-1371
  • Free


Inclusion criteria

Types of participants

This review will consider studies that include acute care, hospitalized, non-critical care patients, 18 years or older, females and males, with all types of conditions or diseases including surgical procedures, and at all stages of severity that required hyperglycemia management.

Types of interventions

This review will include studies that evaluated the effectiveness of basal bolus insulin protocol for hospitalized adult, non-critical care patients, which includes a combination of long and rapid acting insulin regimens as compared to insulin regimens using rapid acting or regular insulin alone for the treatment of hyperglycemia.

Types of outcomes

This review will consider studies that included the following outcome measures:

  • mean daily blood glucose levels;
  • overall mean blood glucose achieved during hospitalization; and
  • episodes of hypoglycemia.

Types of studies

Studies published in English, including from international sources, will be considered for inclusion. This review will consider both experimental and epidemiological study designs including randomized control trials, case controls, observation studies, before and after studies, prospective and retrospective cohort studies.

Search strategy

The search strategy aims to find published studies. Basal insulin was approved for use in the US in 2000; therefore, studies published during or after 2000 will be considered for inclusion in this review. A four-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Databases to be searched include:

Initial keywords to be used will be: basal-bolus, insulin, diabetes, insulin regimens, adults, non-ICU, non-critical care, acute care and hyperglycemia.

Lastly, a comprehensive search of the grey literature will be conducted using the following search engines:

  • Google Scholar
  • Medline Plus

Using key terms and various combinations of key terms, publications will be reviewed for number of hits on the site and their relevance in relation to BBI administration. The search date will be recorded for future reference.

The studies and reports identified during the searches will be assessed for relevance to the review based on the information provided in the title, abstract and descriptor/MeSH terms. A full report will be retrieved for all studies and reports that meet the inclusion criteria. Studies identified from the reference lists of selected studies will be considered, specifically from Diabetes Care, Journal of Clinical Endocrinology and Metabolism, and Annals of Pharmacotherapy. Duplicate studies listed in the initial search outcomes will be removed, as well as studies not published in English. Documents identified from the grey literature will be considered based on potential contribution to the systematic review.

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data extraction

Data will be extracted from papers included in the review using the standardized MAStARI Data Extraction Instrument (JBI-MAStARI) (Appendix II). Data will be extracted by two independent reviewers using the standardized data extraction instrument. The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. In the event that there is missing data or question regarding published findings, a subgroup analysis of findings will be considered and the original authors of the study or report will be contacted. If the two reviewers are unable to come to a consensus regarding data extraction elements, a third associate reviewer will be included in the discussion.

Data synthesis

Quantitative data will, where possible, be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different study designs included in this review as indicated. Where statistical pooling is not possible the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

Conflicts of interest



Texas Christian University JBI Collaborating Center


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                  Appendix I: Appraisal instruments

                  MAStARI appraisal instrument

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                  Appendix II: Data extraction instruments

                  MAStARI data extraction instrument

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                  insulin; basal-bolus; diabetes; adults; non-ICU; non-critical care; acute care; hyperglycemia

                  © 2014 by Lippincott williams & Wilkins, Inc.