HOSPITAL INSULIN PROTOCOL AIMS FOR GLUCOSE CONTROL IN GLUCOCORTICOID-INDUCED HYPERGLYCEMIA

Area of Science:

• Endocrinology
• Pharmacology
• Internal Medicine

Background:

• Glucocorticoids are commonly used medications that can induce hyperglycemia.
• Managing glucocorticoid-induced hyperglycemia in non-intensive care settings presents unique challenges.

Purpose of the Study:

• To compare the effectiveness of two insulin protocols for treating hyperglycemia caused by glucocorticoids.
• To evaluate blood glucose control and hypoglycemia incidence in hospitalized patients.

Main Methods:

• A randomized, open-label, parallel-arm study compared standard Complete Insulin Orders (CIO) with a regimen of Neutral Protamine Hagedorn (NPH) plus CIO (NPH-CIO).
• The primary outcome was mean blood glucose (BG); secondary outcomes included BG in target range (70-180 mg/dL) and hypoglycemia.
• Sixty-one patients were randomized and completed 2-5 inpatient days.

Main Results:

• No significant difference in overall mean BG between CIO and NPH-CIO groups.
• A significant difference in mean BG emerged on day 3, with the NPH-CIO group achieving lower levels (157.2 mg/dL vs. 181.8 mg/dL).
• Percent of BG in target range was higher in the NPH-CIO group (62% vs. 54.6%), and severe hypoglycemia incidence was low and equal in both groups (0.1%).

Conclusions:

• Neutral Protamine Hagedorn (NPH) insulin added to a standard 3-part insulin regimen (CIO) may effectively combat glucocorticoid-induced hyperglycemia.
• Further research with larger populations is warranted to confirm these findings.