HOSPITAL INSULIN PROTOCOL AIMS FOR GLUCOSE CONTROL IN GLUCOCORTICOID-INDUCED HYPERGLYCEMIA.
Endocr Pract. 2015 Oct 22;
Authors: Grommesh B, Lausch MJ, Vannelli AJ, Mullen DM, Bergenstal RM, Richter SA, Fish LH
Abstract
OBJECTIVE: To compare the effectiveness of 2 insulin protocols to treat glucocorticoid-induced hyperglycemia in the non-intensive care hospital setting.
METHODS: A randomized, open-label, parallel-arm study was conducted comparing standard recommended care of complete insulin orders (CIO)-i.e., 3-part insulin regimen of long-acting basal (background), rapid-acting bolus (mealtime), and rapid-acting correction factor-to an experimental group following a regimen of Neutral Protamine Hagedorn (NPH) plus CIO (NPHCIO). The primary outcome was mean blood glucose (BG); secondary outcome was percent of BG in target range of 70-180 mg/dL. Hypoglycemia was also evaluated.
RESULTS: Sixty-one patients completed 2-5 consecutive inpatient days (31 CIO; 30 NPH-CIO). Baseline mean BG results were 237.2 ± 50.2 and 221.9 ± 35.8 mg/dL (P=0.30) in the CIO and NPH-CIO groups, respectively. No significant difference in overall mean BG between the two groups was detected; however, a significant difference arose on day 3: mean BG 181.8 ± 32.6 mg/dL (CIO) vs. 157.2 ± 6.1 mg/dL (NPH-CIO) (P=0.03. Moreover, total daily dose (TDD) of insulin did not differ: 34.8 ± 43.0 units (CIO) vs. 35.8 ± 25.0 units (NPH-CIO) (P=0.13). Percent of BG in target was 54.6% (CIO) and 62% (NPH-CIO) (P=0.24). Incidence of severe hypoglycemia (<50 mg/dL) was the same in both groups (0.1%).
CONCLUSION: NPH added to 3-part insulin regimen (CIO) may be an effective way to combat glucocorticoid-induced hyperglycemia, though further research is needed in a larger population.
PMID: 26492541 [PubMed - as supplied by publisher]