A Retrospective Study Comparing Neutral Protamine Hagedorn Insulin With Glargine As Basal Therapy In Prednisone-Associated Diabetes Mellitus In Hospitalized Patients

Abstract

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.

Efficacy of a basal bolus insulin protocol to treat prednisolone‐induced hyperglycaemia in hospitalised patients

“…A recent study reported that hospitalised patients on prednisone administered insulin glargine and insulin isophane had similar fasting and mean daily glucose concentrations . However, patients in that study receiving insulin glargine were prescribed a higher daily insulin dose than those prescribed insulin isophane .…”

“…20 However, patients in that study receiving insulin glargine were prescribed a higher daily insulin dose than those prescribed insulin isophane. 20 Furthermore, the effect of the two insulin regimens at different time points was not dissected. 20 Our results suggest that further research is needed to define the most effective insulin regimen to treat prednisolone-induced hyperglycaemia, as highlighted in a recent call to action to improve management of inpatient hyperglycaemia.…”

“…20 Furthermore, the effect of the two insulin regimens at different time points was not dissected. 20 Our results suggest that further research is needed to define the most effective insulin regimen to treat prednisolone-induced hyperglycaemia, as highlighted in a recent call to action to improve management of inpatient hyperglycaemia. 21 Mean daily glucose concentration did not fall over the 5 days of follow up.…”

Insulin Requirements in Non-Critically Ill Hospitalized Patients With Diabetes and Steroid-Induced Hyperglycemia

“…9 A recent study showed that administration of NPH and glargine as basal insulin were equally effective in treating patients with prednisone-induce hyperglycemia. 16 Seggelke et al performed a small study in patients with cystic fibrosis receiving methylprednisolone, assessing glucose outcomes in patients treated with glargine and lispro compared with glargine, lispro, and NPH. 17 Results showed that both treatment groups had similar (normoglycemic) fasting blood glucose levels; however, the group that received NPH in addition to the basal-bolus regimen had better pre-lunch and pre-dinner glucose levels.…”

Management of hospitalized type 2 diabetes mellitus patients

“…Although without statistically significat difference, in both articles was found more rate of hypoglycemia in NPH group. [46,47] Surgery Hyperglycemia is associated with increased risk for adverse outcomes in patients undergoing surgery: more length of stay, postoperative complications, infections, and more mortality. [48,49] The recommendations and the treatment depend on the type of diabetes, surgical procedure, when patient is going to resume feeding, previous diabetic treatment, glucose control, and metabolic state of patients.…”