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Add‐on treatment with intermediate‐acting insulin versus sliding‐scale insulin for patients with type 2 diabetes or insulin resistance during cyclic glucocorticoid‐containing antineoplastic chemotherapy: a randomized crossover study
Author(s) -
Gerards M. C.,
de Maar J. S.,
Steenbruggen T. G.,
Hoekstra J. B. L.,
Vriesendorp T. M.,
Gerdes V. E. A.
Publication year - 2016
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.12694
Subject(s) - medicine , chemotherapy , insulin , crossover study , glucocorticoid , diabetes mellitus , subclinical infection , insulin resistance , endocrinology , type 2 diabetes mellitus , hypoglycemia , gastroenterology , placebo , pathology , alternative medicine
The aim of this study was to compare the effectiveness and safety of intermediate‐acting insulin ( IMI ) titrated on body weight and glucocorticoid dose with that of short‐acting sliding‐scale insulin ( SSI ) in patients on recurrent high‐dose glucocorticoid‐containing chemotherapy. We enrolled 26 patients with type 2 diabetes mellitus or random blood glucose level >12 mmol/l in a previous cycle of chemotherapy in a randomized crossover study. In two consecutive cycles of glucocorticoid‐containing chemotherapy, participants were treated with either IMI or SSI , as add‐on to routine diabetes medication. We compared time spent in target range (3.9–10 mmol/l), measured by continuous glucose monitoring ( CGM ), and the occurrence of hypoglycaemia. IMI resulted in a higher proportion of glucose values within target range than SSI (34.4 vs 20.9%; p < 0.001). There were no severe or symptomatic hypoglycaemic events. Two participants in each group had a subclinical hypoglycaemia detected only by CGM . Once‐daily IMI resulted in better glycaemic control than SSI in patients with glucocorticoid‐induced hyperglycaemia during chemotherapy. Safety was not compromised as the incidence of hypoglycaemia was low and not different between both regimens.