Glucocorticoids (GC) represent therapeutic agents of great importance in the treatment and prophylaxis of multiple inflammatory and non-inflammatory conditions. Despite their efficacy, the use of GCs is associated with a variety of side effects, one of the immediate ones being the development of glucocorticoids induced hyperglycemia. GCs decrease peripheral insulin sensitivity, increase hepatic gluconeogenesis, trigger insulin resistance, as well as inhibit pancreatic insulin production.(\[1\] It has been shown that acute and chronic hyperglycemia that are present in many cases in the hospital setting are important risk factors for prolonged hospital stays, infectious complications, poorer surgical outcomes, and increased mortality. In-hospital glucocorticoid induced hyperglycemia is usually managed with optimization of oral anti-diabetic drugs and basal bolus insulin, which has been well established over sliding scale insulin as the preferred regimen for GIH. Through this study we aim to compare to different basal insulins, glargine and degludec in terms of their efficacy and safety (hypoglycemic events) in this setting.
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A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.
basal insulin dose - on Day 1 and Day 5 of basal bolus treatment
Timeframe: for 5 days while admitted to the hospital, from Day 1 of initiation of basal bolus insulin in hospital, to Day 5 of treatment
Bolus insulin dose on Day 1 and Day 5 of treatment
Timeframe: for 5 days while admitted in hospital, from Day 1 of initiation of basal bolus insulin to Day 5 of basal bolus insulin
Estimated average glucose on Day 1 and Day 5 of basal bolus insulin treatment - in mg/dl
Timeframe: for 5 days while admitted in hospital, from Day 1 of initiation of basal bolus insulin to Day 5 of basal bolus insulin
Time in range
Timeframe: for 5 days while admitted in hospital, from Day 1 of initiation of basal bolus insulin to Day 5 of basal bolus insulin
Time above range
Timeframe: for 5 days while admitted in hospital, from Day 1 of initiation of basal bolus insulin to Day 5 of basal bolus insulin
Percent change in coefficient of variation - as measured by continuous glucose monitor - expressed in percentage
Timeframe: for 5 days while admitted in hospital, from Day 1 of initiation of basal bolus insulin to Day 5 of basal bolus insulin
Change in Mean amplitude of glycemic excursions (MAGE) - expressed in mg/dl
Timeframe: for 5 days while admitted in hospital, from Day 1 of initiation of basal bolus insulin to Day 5 of basal bolus insulin
Change in basal insulin, bolus insulin, and total insulin doses from Day 1 to Day 5 in both groups
Timeframe: for 5 days while admitted in hospital, from Day 1 of initiation of basal bolus insulin to Day 5 of basal bolus insulin