title: 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.
abstract: The aim of this study was to compare the effectiveness and safety of intermediate-acting insulin (IMI) titrated on body weight and glucocorticoid dose with that of short-acting sliding-scale insulin (SSI) in patients on recurrent high-dose glucocorticoid-containing chemotherapy. We enrolled 26 patients with type 2 diabetes mellitus or random blood glucose level >12 mmol/l in a previous cycle of chemotherapy in a randomized crossover study. In two consecutive cycles of glucocorticoid-containing chemotherapy, participants were treated with either IMI or SSI, as add-on to routine diabetes medication. We compared time spent in target range (3.9-10 mmol/l), measured by continuous glucose monitoring (CGM), and the occurrence of hypoglycaemia. IMI resulted in a higher proportion of glucose values within target range than SSI (34.4 vs 20.9%; p < 0.001). There were no severe or symptomatic hypoglycaemic events. Two participants in each group had a subclinical hypoglycaemia detected only by CGM. Once-daily IMI resulted in better glycaemic control than SSI in patients with glucocorticoid-induced hyperglycaemia during chemotherapy. Safety was not compromised as the incidence of hypoglycaemia was low and not different between both regimens.
authors.affiliation: Department of internal medicine, MC Slotervaart, Amsterdam, The Netherlands. m.c.gerards@amc.uva.nl.
authors.forename: M C
authors.identifier: 0000-0003-1034-4141
authors.initials: MC
authors.lastname: Gerards
authors.affiliation: Department of internal medicine, Isala, Zwolle, The Netherlands.
authors.forename: J S
authors.initials: JS
authors.lastname: de Maar
authors.affiliation: Department of medical oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: T G
authors.initials: TG
authors.lastname: Steenbruggen
authors.affiliation: Department of internal medicine, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J B L
authors.initials: JB
authors.lastname: Hoekstra
authors.affiliation: Department of internal medicine, Isala, Zwolle, The Netherlands.
authors.forename: T M
authors.initials: TM
authors.lastname: Vriesendorp
authors.affiliation: Department of internal medicine, MC Slotervaart, Amsterdam, The Netherlands.
authors.forename: V E A
authors.initials: VE
authors.lastname: Gerdes
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D019338:Polypharmacy
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D007328:Insulin
keywords: basal insulin; continuous glucose monitoring; glycaemic control; insulin therapy; randomized trial