Bedtime Insulin Supplementation and Effects

Research Article

The research article selected describes a quantitative study performed to assess the effect of bedtime insulin administration as a supplement in the glycemic management of hospitalized patients (Vellanki et al., 2015). The quantitative approach is appropriate in examining the corrective benefit of insulin administration at bedtime in hospitalized hyperglycemic patients. Petznick (2011) holds that the use of basal regimen in the management of hyperglycemia reduces patient blood glucose.

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Research Problem/Objective/Purpose

The problem of the study is clearly stated as Vellanki et al. (2015) highlight the use of point-of-care-test as costly, yet there is no assessed benefit of bedtime insulin supplement in the treatment of diabetic type 2 patients. Practically, the problem is important as it helps in investigating the need for costly point-of-care tests and bedtime insulin administration in the management of hypoglycemia. The objective of the study is to determine the effects of bedtime supplement of insulin in the blood glucose level among hospitalized patients with type 2 diabetes. The authors hypothesized that the administration of bedtime insulin supplement to hospitalized patients with diabetes type 2 lowers the blood glucose level. The authors did not define the key terms used throughout the study, making it hard for the readers to comprehend.

Literature Review

In the article, the section of the literature review is missing. However, Vellanki et al. (2015) have cited relevant studies in introducing the study to provide adequate background knowledge of the topic. The study is relevant and current to the prevailing health and medical needs of modern society. The data from the study participants were collected in the period between 2012 and 2013 with the result findings published in 2015. The prevalence of diabetes has increased due to changes in the lifestyle of modern society, adding a burden on the medical expenses and reduces the quality of life (Richardson, Derouin, Vorderstrasse, Hipkens, & Thompson, 2014). The cited references are recent sources that are too broad with evidence of biases to overreliance on only two articles.


The study approach and design that the study utilized are consistent with not only the purpose but also the framework of the study. The research methodology employed in the study, which is original, is a randomized controlled trial. The sampling criteria involved the inclusion of type 2 diabetic patients both male and female aged 18 to 80 years and exclusion of all other patients whose ages were outside the gap. Vellanki et al. (2015) also employed purposive sampling to exclude patients with no history of more than three months of treatment, patients receiving insulin infusion, pregnant women, children, and those whose blood glucose levels were not between 7.8 and 22.2mmol/L. The sample size (n = 235) is quite small and unreliable to appropriately represent the target population. Emory University institutional review board approved the study and authors sought the informed consent before undertaking the study.

Data Manipulation

The researchers consistently applied relevant strategies in manipulating the variables. All participants were administered with basal insulin in a daily interval and aspart insulin before every meal. The researchers randomized participants to groups receiving bedtime insulin and no bedtime insulin group.

Statistical Procedures and Test Value

The researchers used descriptive statistics assessing the levels of blood glucose levels among patients. Inferential statistics such as Wilcoxon tests in determining the statistically significant difference. The study team observed medical practice standard protocol to protect the participants from any harm by administering aspart to all participants before every meal. Furthermore, healthcare providers were responsible for problems involving patients’ surgical and medical issues while the study team only conducted insulin regimen administration.

Reliability and Validity of Quantitative Measures

Quantitative measures are highly reliable in analyzing the outcome of a given exposure. According to Kassahun, Eshetie, and Gesesew (2016), the validity of quantitative measures is high as it contains primary data of the variables of interest. The authors cited that point-of-care test is a reliable and a valid measurement tool in assessing blood glucose in diabetic patients.

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The researchers used descriptive analysis methods to assess the relationship of the variables and provided information about the incidence of the data average and deviation. The finding of the analysis did not support the hypothesis as the results indicated that there is no beneficial effect of bedtime insulin on blood glucose level (p > 0.05).

Limitations of Study

The study acknowledges that small sample size, sampling from one geographical location, and the use of one regimen are limitations. According to Olokoba, Obateru, and Olokoba (2012), treatment of type 2 diabetes involves the use of various regimens to control blood glucose level.

Further Research

The research identified no significant relationship between bedtime administrations of insulin supplement in small amounts with glycemic management. Inzucchi et al. (2015) argue that there is no beneficial effect on patient’s health resulting in the use of various regimes. Therefore, further study on the topic can focus on investigating the effect of increasing the amount of bedtime insulin supplement on blood glucose level. Further study on this research problem should focus on safety and effect of insulin before meals in hyperglycemic patients. The conclusion of the study relates to the original purpose of assessing the value of bedtime use of insulin in glycemic control.

Use of Article in Practice

Yes, I will use the article in my practice as the source of evidence because the researchers employed existing and reliable literature in building the background of the study. According to Abolghasemi and Sedaghat (2015), evidence-based practices are essential for effective management of diabetes. The authors also utilized proper procedures and methodology in sampling and data collection enhancing professionalism and ethics of research study.


Abolghasemi, R., and Sedaghat, M. (2015). The patients attitude towards type 2 diabetes mellitus, a qualitative study. J relig health, 54(1). P1191-1205

Inzucchi, S., Bergenstal, R., Buse, J., Diamant, M., Ferrannini, E., Nauck,

M.,…Matthews, D. (2015). Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach. Diabetes Care, 38(1), 140-149

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Kassahun, T., Eshetie, T., & Gesesew, H. (2016). Factors associated with glycemic control among adult patients with type 2 diabetes mellitus: a cross-sectional survey in Ethiopia. BMC Research Notes, 9(78), 1-6.

Olokoba, A., Obateru, O., & Olokoba, L. (2012). Type 2 diabetes mellitus: A review of

current trends. Oman Medical Journal, 27(4), 269-273.

Petznick, A. (2011). Insulin management of type 2 diabetes mellitus. American Family Physician, 84(2), 183-190.

Richardson, G., Derouin, A., Vorderstrasse, A., Hipkens, J., & Thompson, J. (2014).

Nurse practitioner management of type 2 diabetes. Nursing Research and Practice, 18(2), 13-108.

Vellanki, P., Bean, R., Oyedokun, F., Paquel, F., Smiley, D., Farrokhi, F., Newton, C.,

Peng, L., and Umpierrez, G. (2015). Randomized controlled trial of insulin supplementation for correction of bedtime hyperglycemia in hospitalized patients with type 2 diabetes. Diabetes Care, 38(1), 568-574.

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