A retrospective study comparing neutral protamine hagedorn insulin with glargine as basal therapy in prednisone-associated diabetes mellitus in hospitalized patients
Open accessAbstract
Objective To compare glycemic outcomes in hospitalized patients with or without type 2 diabetes mellitus receiving neutral protamine Hagedorn insulin (NPH) vs glargine as basal insulin for management of glucocorticoid-associated hyperglycemia.Methods We conducted a retrospective review of electronic medical records in prednisone-treated adult patients with hyperglycemia in a university hospital. Consecutive patients were selected in both the NPH and glargine cohorts using inclusion and exclusion criteria. Baseline characteristics were assessed in each cohort. Glycemic outcomes were analyzed by comparing fasting blood glucose, mean daily blood glucose concentration, median daily blood glucose concentration, and the number of hypoglycemic episodes on a prespecified index day.Results One hundred twenty patients were included: 60 patients in the NPH cohort and 60 patients in the glargine cohort. The weight-based insulin requirement was lower in the NPH cohort than in the glargine cohort (0.27 ± 0.2 units/kg vs 0.34 ± 0.2 units/kg [P = .04] for basal insulin and 0.26 ± 0.2 units/kg vs 0.36 ± 0.2 units/kg [P = .03] for bolus insulin). NPH and glargine cohorts were similar regarding age, sex, race, body mass index, hemoglobin A1c, serum creatinine, and prednisone dosage. Glycemic outcomes in the NPH cohort compared with outcomes in the glargine cohort were similar regarding mean fasting blood glucose concentration (134 ± 49 mg/dL vs 139 ± 54 mg/dL [P = .63]), mean daily blood glucose (167 ± 46 mg/dL vs 165 ± 52 mg/dL [P = .79]), median blood glucose (160 ± 49 mg/dL vs 159 ± 57 mg/dL [P = .90]), and number of hypoglycemic episodes per day (0.12 ± 0.3 vs 0.10 ± 0.3 [P = .77]).Conclusions NPH and glargine appear to be equally effective as basal insulin in the management of hyperglycemia in hospitalized patients receiving prednisone. However, the total daily insulin doses used were lower in the NPH cohort.
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In hospitalised persons with type 2 diabetes mellitus treated with medium-dose to high-dose glucocorticoids, NPH insulin and long-acting insulin glargine as basal insulin in a basal-bolus insulin regimen show similar overall glycaemic control, with no significant differences.
“All three studies show a similar overall glycaemic control for NPH or glargine as basal insulin.35 36 39”
Only Dhital et al found a significantly lower daily insulin requirement in the NPH group.
“Only Dhital et al 39 found a significantly lower daily insulin requirement in the NPH group.”
The three observational studies were classified as having low, middle, and high ranges of risk of bias.
“The three observational studies were classified as having low,38 middle39 and high40 ranges of risk of bias (online supplementary table 2b).”
Insulin requirement was higher in basal-bolus insulin with long-acting insulin compared with NPH as basal insulin in two studies, but it was similar in the other.
“Insulin requirement, however, was higher in BBI with long-acting insulin compared with NPH as basal insulin in two of the studies,36 39 but it was similar in the other.35”
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- Authors
- Dhital, S. M., Shenker, Y., Meredith, M., & Davis, D. B.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Davis, Dawn Belt
- ORCID
- Davis, Dawn Belt
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 18
- Issue
- 5
- Pages
- 712-719
- ISSN
- 1530-891X (ISSN-L)
- PMC
- PMC3671576
- OpenAlex
- W1992396906
- Cited by
- 49
- References
- 23
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 2 · 2019: 4 · 2018: 7 · 2017: 4 · 2016: 8 · 2015: 5 · 2014: 2 · 2012: 1
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Novo Nordisk
- National Institute of Diabetes and Digestive and Kidney Diseases (DK083442, K08DK083442)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- neutral protamine Hagedorn insulin, glargine, basal insulin, prednisone, glucocorticoid-induced hyperglycemia, type 2 diabetes, hospitalized patients, glycemic control, hypoglycemia, insulin requirement, insulin analogues, prednisone withdrawal
- MeSH terms
- Insulin Glargine, Adult, Aged, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Insulin, Isophane, Male, Middle Aged, Prednisone, Retrospective Studies, Insulin, Long-Acting
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