title: A comparison of continuous intravenous insulin and subcutaneous insulin among patients with type 2 diabetes and congestive heart failure exacerbation.
abstract: BACKGROUND
  The study aims to determine whether the route of insulin administration influences glycaemic variability and inflammatory or neurohormonal markers in patients with type 2 diabetes and congestive heart failure (CHF) exacerbation.
  
  
  METHODS
  Patients (n = 65) were randomized to intravenous (IV) insulin (duration 48 h) or subcutaneous (SQ) insulin. Inflammatory cytokines and markers of lipid oxidation, high-frequency heart rate variability (n = 27) and cardiac impedance (pre-ejection period, n = 28) were used to estimate parasympathetic and sympathetic tone in patients with valid cardiac data. Glycaemic variability was measured using a continuous glucose monitor.
  
  
  RESULTS
  Mean glucose was lower (7.7 ± 1.2 vs 9.4 ± 2.7 mmol/L, p = 0.004), coefficient of variation was higher (p = 0.03) and glycaemic lability index was similar on day 1 in the IV group compared with the SQ group, but groups were similar by day 2. The IV group had more confirmed hypoglycaemia (p = 0.005). There were no differences in hospital readmission or hospital length of stay between groups. There were no differences in CHF biomarkers, heart rate variability or pre-ejection period between groups. Increasing log glycaemic lability index was associated with lower on-treatment pre-ejection period (p = 0.03) while increasing coefficient of variation was associated with increasing brain natriuretic peptide (p = 0.004) and paroxonase-1 (p = 0.02). Other univariable analyses were not significant.
  
  
  CONCLUSIONS
  There were modest, transient differences in glucose control between IV and SQ insulin in hospitalized CHF patients. However, the analyses do not support a link between insulin route and inflammatory markers or autonomic tone. Further study is needed to assess outcomes in hospitalized CHF patients.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, OH, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Dungan
authors.forename: Kwame
authors.initials: K
authors.lastname: Osei
authors.forename: Trudy
authors.initials: T
authors.lastname: Gaillard
authors.forename: Jared
authors.initials: J
authors.lastname: Moore
authors.forename: Philip
authors.initials: P
authors.lastname: Binkley
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000473:pathology*; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D061267:Insulin Aspart / Q000008:administration & dosage / Q000009:adverse effects; D007332:Insulin Infusion Systems; D061268:Insulin Lispro / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin; D061268:Insulin Lispro; D061267:Insulin Aspart
keywords: heart failure; insulin; type 2 diabetes