Basal-bolus insulin therapy fails to control glucocorticoidinduced hyperglycemia in patients with severe COPD exacerbation

Abstract

Introduction and objectives: Patients with severe exacerbations of COPD often show hyperglycemia, which predicts adverse outcomes. We evaluated basal-bolus insulin therapy compared with sliding-scale insulin therapy as a treatment for glucocorticoid- induced hyperglycemia in patients with COPD exacerbations. Methods: A pre- and post-intervention study was conducted in the internal medicine department of a 280-bed hospital in Spain. During the intervention phase, we implemented the education and dissemination of inpatient insulin protocols with basal-bolus insulin therapy aimed at blood glucose values from 80 to 180 mg/dL. The primary endpoint was a composite of the need for mechanical ventilation, hospital readmission, or allcause death at 30-day. Secondary endpoints included mean blood glucose during hospital admission, length of hospitalization, and hypoglycemia risk. Results: A total of 99 and 100 patients, pre- and post-intervention were evaluated, respectively. Patients’ mean age was 75 years and 86% were male. A primary endpoint declined from 28 patients pre-intervention to 24 patients post-intervention (p = 0.54); mean in-hospital blood glucose concentration was 223.5 ± 66.6 and 216.8 ± 61.6 mg/dL (p = 0.73), and length of hospitalization was 6.9 ± 3.4 and 6.1 ± 5.0 days (p = 0.12), in the pre- and post-intervention group, respectively. There was a significant reduction in the proportion of patients with hypoglycemia from 12% to 6% in the pre- and post-intervention group, respectively (p = 0.03) Conclusions: Basal-bolus insulin therapy did not lead to reductions in the primary endpoint, mean in-hospital glucose, or length of hospitalization in COPD patients with glucocorticoid-induced hyperglycemia. Basal-bolus insulin therapy showed a lower risk of hypoglycemia.

Keywords

• Diabetes. Insulin. Length of stay. Mortality. Glucocorticoid. COPD.