Evaluación de la eficacia y la seguridad de un protocolo de manejo de pacientes con diabetes descompensada por glucocorticoides durante la hospitalización / Assessment of the efficacy and safety of a protocol to manage glucocorticoid-induced hyperglycemia in diabetic patients during hospital stay

RESUMEN

Introducción: No existen protocolos consensuados de manejo hospitalario de las descompensaciones hiperglucémicas inducidas por dosis farmacológicas de glucocorticoides (GC). Nuestro objetivo fue evaluar la eficacia y la seguridad de un protocolo de insulinización específico para corticoides (PC) frente a un protocolo general (PG) en diabetes descompensada por GC (DDG). Materiales y métodos: Estudio experimental con grupo control, no aleatorizado, en pacientes con DDG ingresados en neumología. Se compararon 2 protocolos (PC y PG), ambos basados en terapia basal-bolo pero con diferentes dosis y distribución de insulina. Se evaluó la diferencia de glucemia media (GM) durante la hospitalización entre el PC y el PG, así como el riesgo de presentar una GM > 200mg/dl, ajustado para potenciales factores de confusión (relacionados con el paciente y con la terapia de GC empleada). Resultados: Se incluyó a 131 pacientes, 60 asignados al PG y 71 al PC. Un 74% de los pacientes estaban ingresados por exacerbación de enfermedad pulmonar obstructiva crónica. Hubo diferencia significativa en la dosis total de insulina entre el PG y el PC (29,4 vs. 57,4 unidades; p < 0,0001). La diferencia ajustada de GM (PC-PG) fue de -14,8 (IC del 95%, -26,2 a -3,3) mg/dl. Los pacientes del PC tuvieron menor riesgo ajustado de presentar GM > 200mg/dl durante la hospitalización (OR = 0,31; IC del 95%, 0,11-0,91; p = 0,033). No hubo diferencias en el riesgo de hipoglucemia grave entre el PG y el PC (0% vs. 1,4%; p = 0,36). Conclusiones: El protocolo estudiado ha demostrado reducir la GM de pacientes con DDG durante la hospitalización sin comprometer su seguridad

ABSTRACT

Introduction: There are no agreed protocols on hospital management of hyperglycemic decompensation induced by pharmacological doses of glucocorticoids (GCs). The study objective was to assess the efficacy and safety of an insulin therapy protocol specific for patients treated with glucocorticoids (CP) as compared to a general protocol (GP) in diabetes decompensation secondary to glucocorticoids. Materials and methods: An experimental study in patients with glucocorticoids-induced decompensated diabetes admitted to a respiratory ward including a non-randomized control group. Two protocols (CP and GP), both based on basal-bolo insulin regimens, but with different insulin doses and distribution, were compared. The difference in mean blood glucose (MBG) levels between both protocols was measured during hospital stay, as was the risk of having MBG levels > 200mg/dL, adjusted for potential confounding factors (related to patients and to the glucocorticoid therapy used). Results: A total of 131 patients were included, 60 assigned to the GP and 71 to the CP groups. Seventy-four percent of patients had been admitted due to COPD exacerbation. There was a significant difference in the total daily insulin dose used between the CP and GP groups (29.4 vs. 57.4 IU; P<.0001). The adjusted difference in MBG levels (CP-GP) was -14.8 (95% CI, -26.2 to -3.3) mg/dL. Patients in the CP group had a lower adjusted risk of having MBG levels >200mg/dL during hospital admission (OR=0.31; 95% CI, 0.11-0.91; P=.033). There were no differences in the risk of severe hypoglycemia between the CP and GP groups (0% vs. 1.4%; P=.36). Conclusions: The study protocol has been shown to decrease MBG levels in patients with glucocorticoids-induced decompensation of diabetes during hospital admission without compromising their safety