Comparing conventional and analogue insulin in hospitalised patients.
*Specialist, **Registrar, ***Consultant and HOD, Department of Diabetes and Endocrinology, Manipal Hospital, Bangalore Received: 19.01.2012; Revised: 18.11.2013; Re-revised: 12.12.2013; Accepted: 01.01.2014 Sir, I analogues are available for clinical use over the last two decades and have shown to be beneficial in reduction of hypoglycaemia, better control of post-prandial hyperglycaemia, less weight gain and possible little better overall glycaemic control in terms of reduction of HbA1C.1 A Good glycaemic control in hospital is expected to improve general well being, reduce the risk of infection (particularly in the postoperative period), hasten the resolution of infection, prevent acute metabolic decompositions (Diabetes ketoacidosis and hyperosmolar non-ketotic coma) and facilitate wound healing. Adverse outcomes l ike hospi ta l mor ta l i ty , infection, heart failure after myocardial infarction, need for ICU admission and hospital length of stay are more frequent among hospitalised patients with uncontrolled hyperglycaemia. O p t i m a l g l y c a e m i c c o n t r o l i s t h e recommended modality now to improve clinical outcomes. Despite our best effort using a standardised in-hospital diabetes protocol we have documented that getting a good control in patients admitted with diabetes for reason other than diabetes is not easy. Here in this study we wanted to see whether insulin analogue is better than conventional Insulin in managing diabetes in hospital. Patients admitted to our hospital for both medical and surgical wards for reasons other than diabetes were included in the study and randomised in 1:1 ratio to use conventional and analogue insulin. Patient admitted for DKA, HONK, patient receiving steroid medications, gestational diabetes and hospital stay less than three days were excluded from the study. Patients with ketonuria on admiss ion were a lso excluded from the study. The study was conducted in accordance with the declaration of Helsinki and good clinical practice guidelines. The protocol was approved by our institutional ethics committee. Patients were started on GIK regimen when not eating and were switched to subcutaneous basalbolus regimen with blood glucose monitoring six times per day when started eating orally. For the purpose of this study our target blood glucose was 80-140 mg/dl on GIK regimen and 80-120 mg/dl before meals while post meal and bedtime target range was 120-180 mg/dl. Glycaemic control was considered good when more than 80% of the glucose readings were in the target range, suboptimal when 40 – 80% of glucose readings were in the target and poor control when less than 40% of glucose readings were in the target range. While on SC insulin, if the control was good for two consecutive days the insulin regimen was downtitrated to two doses of premix insulin, be it conventional or analogue. If the control on SC insulin was poor or if any two blood glucose values in a day were above 300 mg/dL, insulin regimen was up-titrated to thrice-daily premix regimen. A total of 244 patients were included in this study. 121 patients received convent ional insul in and the res t analogue. The baseline characteristics of two treatment arms were similar. On GIK regimen, glycaemic control was identical in both treatment arms. With subcutaneous insulin, pre-meal and post-meal blood glucose was better with CorrespondenCes