Hospital Insulin Protocol Aims for Glucose Control in Corticosteroid-induced Hyperglycemia

Phase 4

Completed

Interventions: Drug: NPH insulin plus Complete Insulin Orders
Drug: Complete Insulin Orders

Brief Summary: The objective of this study is to determine the best insulin regimen for hospitalized patients who receive high doses of steroids who have high blood glucose.

Detailed Description: The overall study objective of this research is to establish the efficacy and assure the safety of achieving glycemic control in hospitalized patients who receive greater than physiologic doses of steroids. This study will compare 2 methods of achieving glycemic control in hospitalized patients who develop steroid-induced hyperglycemia (blood glucose (BG) \>180 mg/dL): 1) a study-specific steroid NPH dosing algorithm plus standard recommended care (Experimental group) vs. 2) the standard recommended care (Methodist Hospital Complete Insulin Orders (Control group).

Recruitment & Eligibility

Inclusion Criteria

Men or women aged ≥18 years who receive steroids in doses greater than physiologic replacement levels of ≥ 10 mg Prednisone or its equivalent of dexamethasone or methylprednisolone.
Have signed the consent form for the study
Have a BG > 180 mg/dL any time during the first 24 hour of steroid administration that is above physiological replacement ( ≥ 10 mg Prednisone or equivalent)
Are scheduled to be in hospital ≥ 2 days.

Exclusion Criteria

Unable to read or understand English
History of psychiatric disability affecting informed consent or compliance with drug intake
Type 1 diabetes
Acute or chronic renal failure (creatinine clearance < 30 mL/min estimated by method of Cockcroft and Gault)
Patients in Hospice Care
Age <18 years
Previously enrolled in this study.
Not appropriate for the steroid protocol in judgment of the principal investigator and/or attending physician.

Arm && Interventions

Group	Intervention	Description
Experimental group	NPH insulin plus Complete Insulin Orders	a study-specific steroid (NPH) dosing algorithm plus standard recommended care. The intervention is Neutral Protamine Hagedorn (NPH) insulin plus complete insulin orders (CIO).
Control group	Complete Insulin Orders	the standard recommended care (Methodist Hospital Complete Insulin Orders)

Primary Outcome Measures

Name	Time	Method
Mean Blood Glucose of All Readings	starting 3 hours after the initial index BG>180 measure, across the entire hospital stay or up through 5 days if hospital LOS is > 5 days	Starting 3 hours after the initial index blood glucose (BG) \>180 measure, across the entire hospital stay or up through 5 days if hospital length of stay (LOS) is \> 5 days

Secondary Outcome Measures