Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Influence of Insulin Therapy in Patients Admitted to Hospital With Acute Exacerbations of Chronic Obstructive Pulmonary Disease
The purpose of this study is to determine the effect of preventing hyperglycaemia in patients admitted to hospital with acute exacerbations of chronic pulmonary disease.
Hyperglycaemia is associated with increased morbidity and mortality in patients admitted to
hospital with acute critical illness, myocardial infarction and stroke. Moreover patients
with hyperglycaemia have a significantly longer hospital stay, higher rates of ICU
admission, increased in-hospital mortality and are more likely to require transfer to a
nursing home. Recently, interventional studies have linked reversal of hyperglycaemia to
better clinical outcomes especially in acute myocardial infarction, cardiac surgery and in
critically ill patients.
In England and Wales, it is estimated that the number of people with COPD is approaching 1.5
million. The morbidity and economic costs associated with the condition are extremely high
with approximately 10% of all acute medical admissions caused by exacerbations of the
underlying condition. As a corollary about 15% of patients with COPD need admission to
hospital each year.
Acute hyperglycaemia is common among patients admitted with acute exacerbations of COPD. The
reasons for this are likely to be multi-factorial including an association between COPD and
increased risk of developing diabetes at least in women, the elderly nature of the two
populations and the use of glucocorticoids which markedly increases the risk of
hyperglycaemia. Admission hyperglycaemia (>11 mmol/l) also appears to predict increased
morbidity for patients with COPD admitted to intensive care.
The trial will be a randomised trial of comparison of usual treatment vs intensive insulin
treatment for patients with COPD who may or may not have diabetes. Patients will take part
in the trial for the first 5 days during their hospital stay.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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