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 respi

•Compare efficacy of insulin glargine vs. NPH for the management of corticosteroid hyperglycemia.•Our study is the first randomized clinical trial to compare these two regimens.•The mean blood glucose during the study did not differ significantly between the groups.•The results from CGM were concordant with those obtained with capillary blood glucose readings.•Both regimens insulin appear to be equally effective in terms of glucocorticoid hyperglycemia.

AimsTo investigate the clinical efficacy and safety of insulin glargine compared with NPH insulin as basal insulin for the management of corticosteroid-induced hyperglycemia in hospitalized people with type 2 diabetes (T2DM) and respiratory disease.Materials and methodsRandomized, two-arm parallel group, clinical trial undertaken from February 2011 to November 2012 on the pneumology ward of the Hospital Regional Universitario de Málaga (Spain), involving 53 participants with T2DM treated with medium/high doses of intermediate-acting corticosteroids. Participants were randomly assigned to receive one single dose of insulin glargine or NPH insulin in three equally divided doses before each meal as basal insulin within a basal–bolus insulin protocol. The intervention lasted six days or until discharge if earlier.ResultsNo significant differences were seen between groups during the study in mean blood glucose (11.43 ± 3.44 mmol/l in glargine vs. 11.88 ± 2.94 mmol/l in NPH, p = 0.624), and measures of glucose variability (standard deviation 3.27 ± 1.16 mmol/l vs. 3.61 ± 0.99 mmol/l, p = 0.273; coefficient of variation 1.55 ± 0.33 mmol/l vs. 1.72 ± 0.39 mmol/l, p = 0.200). Results from CGM were concordant with those obtained with capillary blood glucose reading. The length of hospital stay was also similar between groups (8.2 ± 2.8 days vs. 9.8 ± 3.4 days, p = 0.166) There was a non significant trend for lower episodes of mild (4 vs. 8, p = 0.351) and severe hypoglycemia (0 vs. 3, p = 0.13) in the glargine group.ConclusionsThe results of this study showed that insulin glargine and NPH insulin are equally effective in a basal–bolus insulin protocol to treat glucocorticoid-induced hyperglycemia in people with T2DM on a pneumology ward.