Hospital insulin protocol aims for glucose control in glucocorticoid-induced hyperglycemia
Abstract
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%).Conclusion 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.
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In persons with or without type 2 diabetes mellitus, addition of NPH insulin together with a glucocorticoid to a basal-bolus insulin regimen showed no advantage for glycaemic control, mean total daily insulin dose, or hypoglycaemia and hyperglycaemia.
“The study showed that there was no advantage in this for glycaemic control, mean total daily insulin dose, or hypoglycaemia and hyperglycaemia (table 2).”
One study compared BBI regimen with long-acting insulin to the same regimen with the addition of NPH insulin.
“One study compared BBI regimen with long-acting insulin to the same regimen with the addition of NPH insulin.34”
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- Authors
- Grommesh, B., Lausch, M. J., Vannelli, A. J., Mullen, D. M., Bergenstal, R. M., Richter, S. A., & Fish, L. H.
- Affiliations
- Park Nicollet Methodist Hospital (US)
- Hennepin County Medical Center (US)
- Corresponding author
- Lausch, Mamie J.
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 22
- Issue
- 2
- Pages
- 180-189
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W2176972491
- Cited by
- 52
- References
- 24
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 6 · 2023: 2 · 2022: 7 · 2021: 8 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 4 · 2016: 5
- FWCI
- 4.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- 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
- glucocorticoid-induced hyperglycemia, insulin therapy, NPH insulin, multiple daily insulin injections, glycemic control, hypoglycemia, total daily insulin dose
- MeSH terms
- Adult, Aged, Aged, 80 and over, Algorithms, Blood Glucose, Female, Glucocorticoids, Hospitalization, Humans, Hyperglycemia, Male, Middle Aged, Patient Care Planning, Treatment Outcome
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