HOSPITAL INSULIN PROTOCOL AIMS FOR GLUCOSE CONTROL IN GLUCOCORTICOID-INDUCED HYPERGLYCEMIA.
OBJECTIVE
To compare the effectiveness of 2 insulin protocols to treat glucocorticoid-induced hyperglycemia in the nonintensive 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 (NPH-CIO). The primary outcome was mean blood glucose (BG), and the secondary outcome was percent of BG in target range of 70 to 180 mg/dL. Hypoglycemia was also evaluated.


RESULTS
Sixty-one patients completed 2 to 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 = .30) in the CIO and NPH-CIO groups, respectively. No significant difference in overall mean BG between the 2 groups was detected; however, a significant difference arose on day 3: mean BG 181.8 ± 32.6 mg/dL (CIO) versus 157.2 ± 6.1 mg/dL (NPH-CIO) (P = .03). Moreover, the total daily doses (TDDs) of insulin did not differ: 34.8 ± 43.0 units (CIO) versus 35.8 ± 25.0 units (NPH-CIO) (P = .13). Percent of BG in target was 54.6% (CIO) and 62% (NPH-CIO) (P = .24). Incidence of severe hypoglycemia (<50 mg/dL) was the same in both groups (0.1%).


CONCLUSIONS
NPH added to 3-part insulin regimen (CIO) may be an effective way to a combat glucocorticoid-induced hyperglycemia, though further research is needed in a larger population.
Bethany
B
Grommesh
Mamie J
MJ
Lausch
Anna J
AJ
Vannelli
Deborah M
DM
Mullen
Rich M
RM
Bergenstal
Sara A
SA
Richter
Lisa H
LH
Fish
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D016896:Treatment Outcome
D001786:Blood Glucose; D005938:Glucocorticoids