The online version of this article (https://doi.org/10.1007/s13300-018-0468-3) contains supplementary material, which is available to authorized users.
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Hospitalized patients with diabetes receiving corticosteroids are at risk of developing hyperglycemia and related complications. This study evaluated a neutral protamine Hagedorn (NPH) insulin-based protocol in improving glycemic control in hospitalized patients receiving corticosteroids.
This was a randomized, prospective, non-blinded study in an inpatient setting involving patients with diabetes who were hospitalized and receiving prednisone ≥ 10 mg per day or equivalent. High dose corticosteroids group (prednisone > 40 mg/day or equivalent) received NPH insulin 0.3 U/kg between 0600 and 2000 hours if eating or 0.2 U/kg between 2000 and 0600 hours if not eating. Low dose corticosteroids group (prednisone 10–40 mg/day or equivalent) received 0.15 U/kg between 0600 and 2000 hours if eating or 0.1 U/kg between 2000 and 0600 hours if not eating. Primary outcome measure was mean blood glucose level measured pre-meal and at bedtime for days 1–5.
Mean blood glucose level was lower in the intervention (n = 29) than in the usual care (n = 31) group [226.12 vs. 268.57 mg/dL, respectively, (95% CI for difference − 63.195 to − 21.695), p < 0.0001]. Significant differences in mean glucose level were noted at fasting [170.96 vs. 221.13 mg/dL, respectively, (95% CI for difference − 72.70 to − 27.63), p < 0.0001] and pre-lunch [208 vs. 266.48 mg/dL, respectively, (95% CI for difference − 86.61 to − 30.36), p < 0.0001].
In hospitalized patients with diabetes receiving corticosteroids, an NPH insulin-based protocol improves glycemic control.
ClinicalTrials.gov Identifier: NCT01970241.
Eli Lilly and Company.
Supplementary material 1 (PDF 64 kb)13300_2018_468_MOESM1_ESM.pdf
Weiser MA, Cabanillas ME, Konopleva M, et al. Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexate-cytarabine regimen. Cancer. 2004;100(6):1179–85. CrossRefPubMed
Ganji MR, Charkhchian M, Hakemi M, et al. Association of hyperglycemia on allograft function in the early period after renal transplantation. Transpl Proc. 2007;39(4):852–4. CrossRef
Gerards MC, de Maar JS, Steenbruggen TG, Hoekstra JB, Vriesendorp TM, Gerdes VE. Add-on treatment with intermediate-acting insulin versus sliding-scale insulin for patients with type 2 diabetes or insulin resistance during cyclic glucocorticoid-containing antineoplastic chemotherapy: a randomized crossover study. Diabetes Obes Metab. 2016;18(10):1041–4. CrossRefPubMed
Ruiz de Adana MS, Colomo N, Maldonado-Araque C, et al. Randomized clinical trial of the efficacy and safety of insulin glargine vs. NPH insulin as basal insulin for the treatment of glucocorticoid induced hyperglycemia using continuous glucose monitoring in hospitalized patients with type 2 diabetes and respiratory disease. Diabetes Res Clin Pract. 2015;110(2):158–65. CrossRefPubMed
Lakhani OJ, Kumar S, Tripathi S, Desai M, Seth C. Comparison of two protocols in the management of glucocorticoid induced hyperglycemia among hospitalized patients. Indian J Endocr Metab. 2017;21:836–44. CrossRef
- Glycemic Control in Hospitalized Patients with Diabetes Receiving Corticosteroids Using a Neutral Protamine Hagedorn Insulin Protocol: A Randomized Clinical Trial
Jamil B. Alkhaddo
- Springer Healthcare
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