Use of NPH Versus Basal Bolus Insulin for Steroid Induced Hyperglycemia
Summary
Glucocorticoids are known to cause an increase in insulin resistance, leading to hyperglycemia, in both diabetic and non-diabetic patients. In both the inpatient and outpatient setting, steroids are used for their anti-inflammatory property to treat a variety of conditions. There is a paucity of information regarding the best way to treat steroid-induced hyperglycemia. In this study we will compare (1) the addition of NPH insulin, an intermediate-acting insulin, given at the time of steroid administration to the patient's standard basal/bolus insulin to (2) modification of the standard basal-bolus insulin regimen which will consist primarily increasing the prandial doses at lunch and supper in order to determine which regimen is superior for glycemic control.
Timeline
- Start
- 2018-03-27
- Primary completion
- 2019-08-15
- Completion
- 2019-08-15
Outcome
Outcome not reported
Stopped (Enrollment): “Unable to recruit sufficient number of patients”
Publications
- Results Dhital SM, Shenker Y, Meredith M, Davis DB. A retrospective study comparing neutral protamine hagedorn insulin with glargine as basal therapy in prednisone-associated diabetes mellitus in hospitalized patients. Endocr Pract. 2012 Sep-Oct;18(5):712-9. doi: 10.4158/EP11371.OR.
- Results Ruiz de Adana MS, Colomo N, Maldonado-Araque C, Fontalba MI, Linares F, Garcia-Torres F, Fernandez R, Bautista C, Olveira G, de la Cruz JL, Rojo-Martinez G, Valdes S. 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 Nov;110(2):158-65. doi: 10.1016/j.diabres.2015.09.015. Epub 2015 Sep 30.
- Results Radhakutty A, Stranks JL, Mangelsdorf BL, Drake SM, Roberts GW, Zimmermann AT, Stranks SN, Thompson CH, Burt MG. Treatment of prednisolone-induced hyperglycaemia in hospitalized patients: Insights from a randomized, controlled study. Diabetes Obes Metab. 2017 Apr;19(4):571-578. doi: 10.1111/dom.12859. Epub 2017 Feb 17.
- Results Bevier WC, Zisser HC, Jovanovic L, Finan DA, Palerm CC, Seborg DE, Doyle FJ 3rd. Use of continuous glucose monitoring to estimate insulin requirements in patients with type 1 diabetes mellitus during a short course of prednisone. J Diabetes Sci Technol. 2008 Jul;2(4):578-83. doi: 10.1177/193229680800200408.
- Results Seggelke SA, Gibbs J, Draznin B. Pilot study of using neutral protamine Hagedorn insulin to counteract the effect of methylprednisolone in hospitalized patients with diabetes. J Hosp Med. 2011 Mar;6(3):175-6. doi: 10.1002/jhm.874. No abstract available.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | NPH insulin | Protein / enzyme biologic | — | — |
| Subject | insulin aspart | Protein / enzyme biologic | 0.08 iu/kg | — |
| Subject | insulin aspart | Protein / enzyme biologic | 0.1 iu/kg | — |
| Subject | insulin aspart | Protein / enzyme biologic | 0.15 iu/kg | — |
| Subject | insulin aspart | Protein / enzyme biologic | 0.2 iu/kg | — |
| Subject | insulin aspart | Protein / enzyme biologic | 0.25 iu/kg | — |
| Subject | insulin aspart | Protein / enzyme biologic | 0.3 iu/kg | — |
| Subject | insulin aspart | Protein / enzyme biologic | 0.35 iu/kg | — |
| Subject | insulin aspart | Protein / enzyme biologic | 0.4 iu/kg | — |
| Subject | insulin glargine | Protein / enzyme biologic | 0.25 iu/kg | — |
| Subject | insulin glargine | Protein / enzyme biologic | 0.3 iu/kg | — |