Type 2 Diabetes Mellitus Clinical Trial
Official title:
Comparison of Neutral Protamine Hagedorn (NPH) and Lantus Based Insulin Regimen in the Management of Hypoglycemia in the Hospitalized Patients in Noncritical Care Setting
The goal of the current study is to determine difference in glycemic control between traditional split mix regimen with Neutral Protamine Hagedorn (NPH) and regular insulin vs basal bolus regimen with glargine and humalog in a population of type 2 diabetes commonly encountered in the investigators county hospital setting which include newly diagnosed type 2 patients and patients on relatively high dose of insulin (dose >0.4 units/kg body weight. Primary outcome of the study is to determine differences in glycemic control between treatment group as measured by the mean daily blood glucose. Secondary outcome is to measure number of hypoglycemic events, number of severe hypoglycemia and length of hospital stay.
The effect of insulin depends not only on the pharmacokinetics and pharmacodynamics of a
particular preparation, but also on patient specific factors which includes state of
inflammation, obesity etc. Although effect on glucose disposal is the central to insulin
action, there could be differences of insulin action on other metabolic parameters. It is not
known if there is a difference in suppression of inflammation with improved glycemic control
which could vary with analog insulin. It is unknown if natural insulin (NPH, recombinant
human insulin with protamine) differs from insulin analogs (glargine and detemir, made by
substituting amino acid in the native sequence) in terms of metabolic outcome other than
glucose disposal.
At this point it is uncertain if there is any clear benefit of use of lantus over NPH in
inpatient glycemic management. Currently, both lantus and NPH based regimen is practiced in
inpatient hospital setting. Current practice of inpatient insulin regimen is based more on
familiarity of physicians with a particular insulin type and personal preference rather than
evidenced based knowledge. Lantus is an expensive insulin preparation compared to NPH with
uncertain benefit in inpatient setting. Current research proposal will compare this two
insulin based regimen in the management of diabetes of hospitalized patients. Information
obtained through this research will guide the investigators practice in this institution as
well as in other institutions.
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