Insulin NPH for steroid-induced hyperglycemia: Predictors for success

Study Objective This study aimed to evaluate the efficacy of insulin neutral protamine Hagedorn (NPH) for steroid-induced hyperglycemia and identify factors associated with achievement of euglycemia. Design Retrospective, single center, cohort analysis. Setting Quaternary care academic medical center. Patients Adult patients with steroid-induced hyperglycemia on combination therapy of an intermediate-acting steroid and once daily NPH. Intervention The primary outcome was the percentage of patients who achieved euglycemia on day 3 of combination therapy. Patients were divided into euglycemic and dysglycemic cohorts based on the primary outcome. Univariate analysis on baseline characteristics, NPH dose, and steroid dose based on prednisone equivalent dose (PED) was conducted to identify differences between the cohorts. Safety analysis was conducted to detect differences between the two cohorts. Measurements and Main Results Of 142 patients included in the primary analysis, 50 (35.2%) achieved euglycemia on day 3 of combination therapy. In univariate analysis, patients who achieved euglycemia had significantly higher median NPH dose standardized to steroid dose on day 1 (0.5 units/mg PED [25%-75% interquartile range (IQR) 0.4-0.8] vs 0.4 units/mg PED [0.2-0.8]; p = 0.046), lower median blood glucose prior to combination therapy on day 3 (111 mg/dl [96-160] vs 136 mg/dl [113-198]; p = 0.008), and lower median blood glucose 4 hours after administration of combination therapy on day 3 (147 mg/dl [116-197] vs 190 mg/dl [153-245]; p = 0.003) compared to patients who did not achieve euglycemia, respectively. Hypoglycemia and life-threatening hypoglycemia occurred at similar rates between the two cohorts. Conclusions Neutral protamine Hagedorn is a safe and efficacious option for acute care hospitalized patients experiencing steroid-induced hyperglycemia. More aggressive dosing initiation of NPH based on steroid dose may allow for earlier achievement of euglycemia without a difference in hypoglycemia.