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

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2016-10, Vol.18 (10), p.1041-1044
• Main Authors: Gerards, M. C., de Maar, J. S., Steenbruggen, T. G., Hoekstra, J. B. L., Vriesendorp, T. M., Gerdes, V. E. A.
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; basal insulin; Blood Glucose - drug effects; Blood Glucose - metabolism; Blood levels; Body weight; Chemotherapy; continuous glucose monitoring; Cross-Over Studies; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Drug Administration Schedule; Female; Glucocorticoids; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Glucose; Glucose monitoring; glycaemic control; Humans; Hyperglycemia; Hypoglycemia; Insulin; Insulin - administration & dosage; Insulin - adverse effects; Insulin - analogs & derivatives; Insulin resistance; Insulin Resistance - physiology; insulin therapy; Male; Middle Aged; Neoplasms - blood; Neoplasms - complications; Neoplasms - drug therapy; Polypharmacy; randomized trial
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.12694

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